Real-world effectiveness of biologic therapy in Allergic Bronchopulmonary Aspergillosis

Résumé fourni par la source

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a severe hypersensitivity reaction to Aspergillus species colonising the airways of asthmatic patients with limited licensed therapeutic options. Biologic or monoclonal antibody therapy has shown therapeutic promise in small case series. Aim: To assess the real-world efficacy of biologic therapy in patients with ABPA. Methods: Retrospective single-centre analysis of patients with ABPA (defined by ISHAM criteria) receiving monoclonal therapy between 2014-2022. 12-month therapeutic response was defined as ≥ 50% reduction in maintenance oral corticosteroid (OCS) use or ≥ 50% reduction in annual exacerbation rate. Results: 74 patients received biologic therapy (65% anti-interleukin (IL) 5/5-Ra; 32% anti-immunoglobulin-E; 3% anti-IL4-Ra). Overall, biologic therapy reduced ACQ-6 scores (p=<0.0001), exacerbation frequency (p=<0.0001) and maintenance oral OCS use (p=0.0173). 65% of patients achieved a therapeutic response at 12 months. 28% discontinued due to inadequate response, 6% due to side effects and 1% due to medical co-morbidities. Univariate analysis revealed mucus plugging was associated with non-response of symptoms to biologic therapy (p=0.0189). Bronchiectasis was associated with a lower response rate, although this did not reach statistical significance (p=0.16). Additionally, microbiological colonization did not correlate with the response to biologic therapy. Conclusion: We highlight the favourable real-world effectiveness of biologic therapy in patients with ABPA. Future prospective research is required for confirmation and to better understand ABPA endotype-therapy response relationships.

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