Real-world effectiveness of interleukin-5/5Ra targeted biologics in severe eosinophilic asthma with comorbid bronchiectasis.

BACKGROUND: Bronchiectasis is a common co-morbidity in patients with asthma and associated with increased disease severity. In patients with severe eosinophilic asthma biologics targeting interleukin (IL)-5/5Ra have shown beneficial effects on oral corticosteroid (OCS) use and exacerbation frequency. However, how coexisting bronchiectasis affects the response to these treatments is unknown.

OBJECTIVE: To evaluate the real-world effectiveness of anti-IL-5/5Ra therapy in patients with severe eosinophilic asthma and comorbid bronchiectasis on exacerbation frequency and daily maintenance and cumulative OCS dose.

METHODS: This real-world study evaluated data from 97 adults with severe eosinophilic asthma and computed-tomography-confirmed bronchiectasis from the Dutch Severe Asthma Registry (RAPSODI) who initiated anti-IL5/5Ra biologics (mepolizumab, reslizumab, benralizumab) and had follow-up data ≥12 months. Analysis was performed in the total population and subgroups with or without maintenance OCS use.

RESULTS: Anti-IL-5/5Ra therapy significantly reduced exacerbation frequency, both in patients with or without maintenance OCS use. 74.5% of all patients had ≥2 exacerbations in the year prior to biologic initiation, which decreased to 22.1% in the follow-up year (p<0.001).The proportion of patients on maintenance OCS decreased from 47% to 30% (p<0.001) and in the OCS dependent patients (n=45) maintenance OCS dose decreased from median (IQR) 10.0 (5-15) to 2.5 (0-5) mg/day after 1 yr. (p<0.001).

CONCLUSION: This real-world study shows that anti-IL-5/5Ra therapy reduces exacerbation frequency and daily maintenance as well as cumulative OCS dose in patients with severe eosinophilic asthma and comorbid bronchiectasis. Though an exclusion criterion in phase 3 trials, comorbid bronchiectasis should not preclude anti-IL-5/5Ra therapy in patients with severe eosinophilic asthma.