Adjunctive Reslizumab Reduces Exacerbations, OCS Use in Severe Eosinophilic Asthma | Latest news for doctors, nurses and pharmacists
Reslizumab, a biologic that targets interleukin (IL)-5, reduced the rate of severe asthma exacerbation and the use of oral corticosteroids (OCS) in people with severe eosinophilic asthma, according to a study. real-life study using RAPSODI* data at patient level.
“Beneficial effects were evident not only in patients receiving reslizumab as a first add-on biologic, but also demonstrated additive efficacy…in those who had previously failed another type 2 biologic and switched to reslizumab “, said the researchers.
Participants (n=134; mean age 53 years, 52% male) started reslizumab 0.3 mg/kg (infusions every 4 weeks) before April 2020 and had follow-up data for ≥ 6 months after the beginning. They were classified as either initiators (biologic naïve reslizumab initiators; n = 56) or switchers (those who switched from another type 2 biologic drug; n = 78). [J Allergy Clin Immunol Pract 2022;10:2099-2108.e6]
In the overall population, reslizumab significantly reduced the annualized exacerbation rate (AER; odds ratio [OR], 0.10; p
The proportion of OCS users also dropped significantly in the overall cohort (from 58% to 40%; OR, 0.20; p
“Remarkably, reslizumab treatment [in switchers] showed further improvement in exacerbation rate and OCS use… [This] suggests reslizumab offered added value over previous type 2 biologics, including those targeting IL-5 in half of patients,” the researchers said.
These findings were reinforced by an anonymous survey of physicians conducted to determine whether the experts’ actual clinical experience with reslizumab matched the findings. The survey showed that asthma experts recognize the added benefit of reslizumab.
Although none of the 10 respondents prescribed reslizumab solely as a first adjunctive therapy, 40% did so as a second or third adjunctive biologic, while 60% prescribed reslizumab both as a first and second or third adjunct biological agent. Almost all were satisfied/very satisfied with reslizumab; 80% found reslizumab to have added value over other biologics.
“To justify the prescription of reslizumab, 50% responded that they expected patients to respond better to reslizumab than to other type 2 biologics,” the researchers said.
Other notable points
Most of the participants had different characteristics than the patients in the phase III trials, which the researchers believe could have prevented participation in the trials. “Despite these differences…the beneficial effects of reslizumab in the real world were broadly comparable to those in the phase III trials. This suggests that in the real world, reslizumab is effective even if the strict inclusion criteria for phase III trials are not fully met,” they said.
“Another remarkable finding…is that patients who were prescribed reslizumab in the real world appeared to have more severe asthma than those included in phase III trials,” they continued. Indeed, most participants were at the extreme end of asthma severity and complexity (>50% were OCS-dependent and almost all had comorbidities), “yet only a minority of patients ( 14%) did not improve with this therapy.”
Patients with severe asthma usually have persistent symptoms that could interfere with activities of daily living. [Lancet 2018;391:783-800;
Eur Respir J 2017;50:1700765] “Furthermore, these patients are at increased risk of severe and life-threatening asthma exacerbations that often can only be prevented by frequent courses or continued use of OCS, which are associated with severe side effects at long term,” the researchers said.
“The observed additional effect of reslizumab as a second or third adjunctive therapy suggests that there may be value in switching patients who do not respond adequately to a specific type 2 biologic to a second biologic booster, even though this second biological agent targets the same molecular pathway,” they said.
Further studies need to determine whether greater drug potency, better dosing, pharmacodynamics or pharmacokinetics, or type of antibody or target resulted in improved response in switchers, or whether it is It’s just a longer-term inhibiting effect of the inflammatory process in the airways with so many effective agents, they added.
*RAPSODI: Dutch Registry of Adult Patients with Severe Asthma for Optimal Disease Management