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February 27, 2023
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Biologics reduce exacerbations among patients with asthma, allergic rhinitis

Fact checked byKristen Dowd
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SAN ANTONIO — Patients with severe asthma and allergic rhinitis experienced fewer exacerbations after taking a biologic for 6 months, with greater decreases seen for biologics other than omalizumab, according to the CHRONICLE study.

Warner W. Carr

“In patients with allergic severe asthma, clinicians should consider whether biologics other than omalizumab [Xolair; Genentech, Novartis] may be appropriate, as those biologics may also represent good options for treating a patient’s severe asthma,” Warner W. Carr, MD, FACP, FACAAI, FAAAAI, medical director of Southern California Research at Allergy and Asthma Associates of Southern California Medical Group, told Healio.

Infographic showing decrease in asthma exacerbations among patients with severe asthma and allergic rhinitis after 6 months of treatment.
Data were derived from Carr WW, et al. Abstract 043. Presented at: AAAAI Annual Meeting; Feb. 24-27, 2023; San Antonio.

In the ongoing CHRONICLE observational study of adults treated by subspecialists, Carr and colleagues analyzed 339 patients with severe asthma and allergic rhinitis from February 2018 to February 2022 to determine how treatment with biologics impacted exacerbations in this patient population. They also evaluated performance based on the type of biologic (anti-IgE vs. non-anti-IgE).

Researchers compared annualized asthma exacerbation rates 6 months before and after starting the biologic to observe changes in the number of exacerbations per patient-year and between biologic groups.

Of the total cohort, 107 patients received anti-IgE biologics and 232 patients received non-anti-IgE biologics.

Compared with patients starting non-anti-IgE biologics, medical records showed that patients using anti-IgE had more clinically relevant allergen exposure (76% vs. 61%), reduced blood eosinophil counts (median, 134 cells/µL vs. 379 cells/µL) and elevated total IgE (median, 255 IU/mL vs. 99 IU/mL).

Results, presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting, showed that patients taking non-omalizumab (non-anti-IgE) therapies had 59% fewer asthma exacerbations from 6 months before to 6 months after starting treatment, a drop from 1.6 exacerbations per patient-year to 0.66 per patient-year.

In comparison, patients using omalizumab had 39% fewer exacerbations, a decrease from 1.22 exacerbations per patient-year to 0.74 per patient-year.

“The most interesting finding was that in patients with allergic disease (either allergic rhinitis or elevated total IgE levels), we found lower reductions in exacerbations with omalizumab compared to other biologics,” Carr told Healio. “Omalizumab is frequently used in patients with allergic severe asthma. However, a key limitation is that there were differences in patients receiving omalizumab vs. other biologics, so these results need to be interpreted with caution.

“As we and other investigators gather additional data on the real-world use of different biologics for severe asthma, it will be important to examine differential outcomes by biologic type and across varying patient characteristics,” Carr added.

For more information:

Warner W. Carr, MD, FACP, FACAAI, FAAAAI, can be reached at warnercarr@hotmail.com.