PuSH - Publication Server of Helmholtz Zentrum München: Overall response to anti-IL5/anti-IL5Rα treatment in severe asthma does not depend on initial bronchodilator responsiveness.

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Mümmler, C. ; Suhling, H.* ; Walter, J.* ; Kneidinger, N. ; Buhl, R.* ; Kayser, M.Z.* ; Drick, N.* ; Behr, J.* ; Welte, T.* ; Korn, S.* ; Milger, K.

Overall response to anti-IL5/anti-IL5Rα treatment in severe asthma does not depend on initial bronchodilator responsiveness.

J. Allergy Clin. Immunol. Pract. 10, 3174-3183 (2022)

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BACKGROUND: Positive bronchodilator responsiveness (BDR) (ΔFEV1≥+200ml and ≥+12%) after inhalation of short-acting beta-agonist (SABA) has been an inclusion criterion in licensing trials of anti-IL5/anti-IL5Rα biologics in severe asthma. However, in clinical practice patients with severe uncontrolled asthma frequently show a negative BDR. OBJECTIVE: To investigate whether the response to anti-IL5/anti-IL5Rα therapies differs between patients with positive and negative BDR at baseline. METHODS: Retrospective multicenter analysis of treatment outcomes in patients with severe asthma receiving anti-IL5/anti-IL5Rα stratified for baseline BDR. RESULTS: Of 133 patients included, 37 had a positive and 96 had a negative BDR at baseline. Following anti-IL5/anti-IL5Rα treatment FEV1 improved significantly in both groups compared to baseline (p<0.0001), with no significant difference between patients with positive and negative BDR (ΔFEV1 +493ml vs +306ml, p=0.06). FVC increased (ΔFVC: +85ml vs +650ml, p<0.01) and RV decreased (ΔRV +113ml vs -307ml, p<0.01) significantly in patients with negative BDR. Median annualized exacerbations (0 vs 0; p=0.7), reduction of exacerbation rate (Δexacerbations: 0 vs -2, p=0.07), continuous oral corticosteroid (OCS) use (Δpatients on OCS: -35% vs -39%, p=0.99) and improvement of asthma control test (ACT) score (ΔACT: 6 vs 5, p=0.7) were similar in both groups. Multivariate logistic regression analysis showed no significant correlations of positive vs negative BDR with response parameters. CONCLUSIONS: Both groups improved following treatment with similar responses concerning reduction of OCS therapy, exacerbations and improvement of symptom control. Pulmonary function also improved in both groups during anti-IL5/anti-IL5Rα treatment, with differences in response patterns noted.

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