P19 5-year outcomes of asthma patients on monoclonal antibodies

Le résumé fourni par la source

Monoclonal antibodies targeting type-2 inflammation pathways have revolutionized the management of severe asthma. These significantly reduce exacerbations and improve symptoms, but there is a paucity of long-term data on their use. We conducted an audit of all patients on biologics for asthma under the Oxford Special Airways Clinic to identify those receiving the same treatment for at least 5 years to assess response to treatment including exacerbations and changes in lung function over time. Of the 818 individuals in our cohort, 69 had at least 5 years on the same treatment (Mepolizumab in 66 and Dupilumab in 3). Of these, 43 (62%) had lung function data available after 5 years. There was no significant change in lung function during this period with mean FEV1 (SD) going from 2.02 ± 0.79 L/s to 2.01 ± 0.83 L/s, mean paired-sample difference -0.02 ± 0.38 L/s, p=0.8. There were no significant predictors of change in lung function, but chronic daily sputum production (bronchitis) showed a non-significant association (r=-0.291, p=0.06). Biologics has a significant and sustained effect on exacerbations in this cohort, with the median (IQR) number of exacerbations falling from 4.5 (3.0 – 6.0) in the year prior to biologics to from 0.0 (0.0 – 1.0) to (0.0 – 2.0) per year for all following years. 24 (34.8%) of subjects had no exacerbation during this period. Remaining exacerbation-free at 5 years correlated inversely with the number of exacerbations in the year prior to starting biologics (r=-0.331, p=0.006) and with FeNO at baseline (r=-0.381, p=0.002), and correlated positively with increasing FeNO over the 5-year period (r=-0.480, p=0.002). In conclusion, in our cohort of patients on biologics, individuals who remained on the same treatment for at least 5 years had stable lung function and sustained reduction in exacerbations, and over a third did not have further exacerbations. Residual exacerbations may be related to presence of epithelial-driven inflammation as predicted by elevated FeNO.

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