Concomitant Biologic Use Very Rare in Patients with Asthma

In retrospective data presented at the American College of Allergy, Asthma & Immunology (ACAAI) 2019 Scientific Meeting in Houston, a team of US-based investigators showed less than 1% of patients with asthma treated with mepolizumab (NUCALA) used monoclonal antibodies concomitantly in the 6 months prior or following their treatment start.

Investigators, led by Jean-Pierre Llanos-Ackert, MD, executive medical director and Global Media Affairs lead for Amgen’s Tezepelumab & Pulmonary Pipeline, believe the research warrants follow-up with the impending popularity of the drug class.

There are currently 5 biologic therapies approved by the US Food and Drug Administration (FDA) for the treatment of severe asthma: mepolizumab, dupilumab, benralizumab, omalizumab, and reslizumab. Despite the drug class’ prevalence in varying severe asthma cases, and ongoing research in autoimmune-related conditions, their use as a monotherapy or add-on treatment is far better understood than their benefits concomitantly.

“There is a need to understand the frequency that concomitant biologic treatment occurs and the characteristics of this unique group of patients,” Llanos-Ackert and colleagues wrote. “This study examines the use of non-asthma biologics in a cohort of patients treated with mepolizumab.”

The team retrospectively analyzed a group of patients with written or administration recorded mepolizumab prescription, from the Optum Clinical Database, from November 2015 to October 2017. They captured patient characteristics for the 6 months prior and after first mepolizumab administration, and stratified patients by either mepolizumab monotherapy treatment, or evidenced use of other biologics for non-asthma care.

The patient population included 1271 patients, with just 13 (1%) receiving a non-asthma biologic—each used for an autoimmune disorder. Among the most common comorbidities treated with added biologics were asthma (n = 9), allergies (n = 5), allergic rhinitis (n = 5), hypertension (n = 3), and cardiovascular disease (n = 3). Concomitant use was identified in just 5 of the 13 observed patients.

In instances of patients on mepolizumab switching biologics, the most common conditions associated with their care were asthma (94.4%), allergy (73.6%), and allergic rhinitis (56.8%). Asthma-related use of healthcare by patient showed each had numerous ambulatory visits, few emergency department visits, and no hospitalizations during the baseline or follow-up periods.

The discussion of biologic use is one that has caught steam in light of the growing evidence of each individual agent’s benefit for particular forms of inflammatory care. In an interview with MD Magazine® while at ACAAI 2019, Thomas Casale, MD, professor of medicine at USF Health Morsani College of Medicine, explained the driving factor connecting biologic use in inflammatory disease.

“If you look comorbid conditions that track with asthma—nasal polyps, chronic rhinosinusitis with nasal polyps, you're likely to have that same Th2-driven inflammation,” Casale said. “That's why dupilumab, which was first originally approved for atopic dermatitis, also recently got approved for nasal polyps.”

Casale observed most trials have already observed biologics in combination with controller therapy—particularly for asthma—but that they may have potential in monotherapy use for at-need patients. But further research is warranted.

As Llanos-Ackert and colleagues noted, the opportunities to research their function in various patients will be quickly available.

“While use of multiple biologics was rare in this study, this group warrants future monitoring as the use of biologics to treat many conditions is expected to increase,” they concluded.

The study, “The Frequency of Biologics Prescribed for Other Indications Among Patients with Asthma Treated with Mepolizumab,” was presented at ACAAI.