Asthma Center

Asthma Control in Patients Receiving Advanced Therapies for Severe Asthma With Eosinophilia

Approximately 10% of patients with asthma have severe asthma, defined by the need for high-dose inhaled steroids or oral steroids, either to maintain control or despite which asthma control is still not achieved.¹ In this group, even with optimal therapy, patients experience ongoing symptoms and have higher healthcare utilization. Therapies for severe asthma have significantly advanced in recent years. The Asthma Center uses a personalized approach based on the type of asthma (often referred to as asthma phenotype or endotype). Individuals with or without allergies may have a form of asthma called eosinophilic asthma, which results in significant symptoms and often requires high doses of medications including even oral steroids.

To monitor patients closely for therapeutic response to advanced therapies for severe eosinophilic asthma, such as biologic therapies, Asthma Center providers enroll patients into a registry. The center has > 130 patients enrolled in the registry for various biologics,²⁻⁷ including 112 patients who received an interleukin-5 antagonist called mepolizumab²; 47 of them have been followed > 12 months.

At baseline, this group was 53 ± 12 years old with a median age of asthma onset of 33 ± 7 years; 64% are women. Patients often had significant comorbidities including chronic sinusitis (84%), nasal polyps (47%), gastroesophageal reflux (64%), and sleep disordered breathing (61%). All were similarly using multiple inhaler therapies with inhaled corticosteroids, long-acting beta agonists, leukotriene antagonists, and anti-muscarinic agents. The severity is apparent when noting that 64 patients (58%) were taking chronic oral steroids to manage their asthma.

Improvement in ACT Scores for Patients With Severe Eosinophilic Asthma Treated With Anti-IL-5 Biologic Mepolizumab

2018

For the 112 patients enrolled in the registry, asthma control as measured by ACT scores significantly improved at month 3 compared with month 1 (P < 0.001), and improvement was sustained for those patients who were assessed at subsequent intervals.

Percent of Patients Requiring Chronic Oral Steroid Administration While Receiving Biologic Therapy

2018

In this same cohort, patients demonstrated a significant reduction in need for chronic oral steroids to maintain asthma control.

These outcomes data demonstrate that comprehensive multidisciplinary management of patients presenting to the Asthma Center improves asthma control even in the most severe cases. Rigorous monitoring and adjustments of therapies are needed as patients improve or require alternative advanced therapies available.

References

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  2. Ortega HG, Liu MC, Pavord ID, Brusselle GG, FitzGerald JM, Chetta A, Humbert M, Katz LE, Keene ON, Yancey SW, Chanez P; MENSA Investigators. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014 Sep 25;371(13):1198-1207.
  3. Bleecker ER, FitzGerald JM, Chanez P, Papi A, Weinstein SF, Barker P, Sproule S, Gilmartin G, Aurivillius M, Werkström V, Goldman M; SIROCCO study investigators. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016 Oct 29;388(10056):2115-2127.
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