Evaluating Response to Biologic Therapy in Asthma

This is part of the MD Magazine^® Peer Exchange, “Precision Medicine in the Treatment of Severe Asthma.”Click here for Segment 15 and learn about the significance of the QUEST trial in asthma.

Peter Salgo, MD: You were talking about lung function, right? That’s got to be one marker for these drugs working—these new drugs. Let me get a definitive answer, which I know I can’t. Do they, long term, improve lung function?

Raffi Tachdjian, MD: We don’t know yet. Going back to what is going to make the patient take their medication, I think it’s the intrinsic “I’m feeling better at this point.” Now, the severe ones that Neal brought up who might be episodic once a year, twice a year—they’re playing with fire. And the counter to that is, why use this new class of drugs? Because of the side effects of corticosteroids.

I had a patient’s husband come in and say, “Thank you for restoring my beautiful wife.” These effects of corticosteroids, the adipose tissue, the disfiguration, not to mention what’s going on inside with the bones and density, have changed now. Now we’re looking at the same condition and the same kind of result (reduction of exacerbations), technically, but there is a much cleaner side effect profile.

Peter Salgo, MD: And you reduce exacerbations. Do the patients understand that? Do they, over time, realize, “Hey, I haven’t had a…”

David Rosenstreich, MD: Yes, they do. They are aware of how they’re feeling. And it’s not just exacerbations. In general, they’re feeling better on these drugs. They know they’re using less albuterol. They’re able to take a breath. They wake up and they feel fine. So even though they’re not counting emergency department visits or hospitalizations, they do feel better. Exacerbation is just the tip of the iceberg. Within any day, patients have many exacerbations that are being reduced.

Peter Salgo, MD: And so their general feeling of wellness gets better.

David Rosenstreich, MD: Right.

Raffi Tachdjian, MD: And to use my pithy mark allowance or allotment, it’s the Spinal Tap, “You just went to 11.” “We feel like our 10 is your 10. No, actually, it might be a 7.” And, “Once I’m on better controlled therapy and my exacerbations are controlled and the inflammation is reduced, and hopefully turned off, I’m feeling super human.”

Peter Salgo, MD: I get your meaning. Somebody’s 10 is somebody else’s 11.

Transcript edited for clarity.