Eosinophilic chronic rhinosinusitis, younger age factors linked to switching asthma biologics

The presence of eosinophilic chronic rhinosinusitis and younger age were identified as factors associated with switching biologic therapies among patients with asthma in a new study published in the Journal of Asthma and Allergy.

The retrospective study included 42 patients with severe asthma who were treated with biologic therapy at Hokkaido University Hospital in Japan from June 2016 to April 2021. Researchers compared the characteristics of those who continued their biologic therapy and those who switched to another biologic therapy. The researchers also evaluated the time to switch biologic therapies based on type 2 inflammatory biomarkers, pulmonary function indices and the presence of comorbidities.

Nearly one-third (31%) of patients switched biologic therapies. At baseline, eight were treated with mepolizumab (Nucala, GlaxoSmithKline) and five were treated with benralizumab (Fasenra, AstraZeneca).

Patients who required switching of their biologic therapy were characterized by higher blood eosinophil counts (706 cells/µL vs. 298 cells/µL), younger age (51 years vs. 64 years), Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) score of 11 points or more (61.5% vs. 27.6%) and aspirin-exacerbated respiratory disease (46.2% vs. 10.3%).

Researchers reported a significantly shorter time taken to switch biologic therapy among patient subgroups with JESREC scores of 11 points or more compared with those with low JESREC scores (1,053 days vs. 1,480 days; P < .05) and those with aspirin-exacerbated respiratory disease compared with those without (750 days vs. 1,346 days; P < .05).

In the multivariate Cox proportional hazards model, a JESREC score of 11 or more (HR = 20.8; P = .015) and younger age (HR = 0.91; P = .004) were independently associated with time taken to switch biologic therapy, whereas the presence of aspirin-exacerbated respiratory disease (HR = 0.41; P = .362) and FEV₁ percent predicted (HR = 1.03; P = .137) were not.

“This highlights the significance of assessing comorbidities in the treatment of asthma with biologics,” Machiko Matsumoto-Sasaki, MD, from the department of respiratory medicine and Graduate School of Medicine at Hokkaido University in Sapporo, Japan, and colleagues wrote. “The selection and switching of biologics should be considered holistically and not just based on the organ system.”