Patient characteristics alone may not determine who is a good candidate for biologics for treatment of asthma, according to a recent case study originally released as an abstract for the American Thoracic Society (ATS) Conference 2020.
Carlos Andrés Celis-Preciado, MD, of the pulmonology department at the Hospital Universitario San Ignacio in Bogota, Colombia, and colleagues published the results of a case study involving a 52-year-old man with a 20-year history of asthma and had previous surgery to remove nasal polyps for whom benralizumab was not an effective treatment, but responded well to dupilumab.
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“Treatment of severe T2-high asthma has evolved, new therapeutic options have become available including biologic agents, amongst this the interleukin 5 receptor (IL-5) blocker benralizumab,” he said.
Prior to treatment with benralizumab, the patient was receiving montelukast, high-dose inhaled corticosteroids, a long-acting beta agonist (LABA) and long-acting muscarinic antagonist (LAMA). Despite this treatment, his asthma was not well controlled, achieving an Asthma Control Test (ACT) score of 14 out of 25, experiencing a decrease in lung function, and requiring two short corticosteroid cycles within 1 year.
After applying the Global Initiative for Asthma (GINA) guidelines, the patient underwent a phenotype study and benralizumab was prescribed after predictors for enhanced response to the drug were discovered. The patient began therapy and experienced a worsening of symptoms (ACT score, 9 out of 25) and had another exacerbation needing the use of systemic steroids. He was switched to dupilumab after it was determined he was not responding to benralizumab therapy. Since the patient was switched to dupilumab, he has had a good response to the treatment and there have been no complications, Dr. Celis-Preciado said.
“Benralizumab is a novel promising therapy in the management of severe T2-high asthma that reportedly reduces exacerbations by up to 51%, increases lung function and improves symptom control,” he said. “Some predictors of enhanced response to therapy have been described including higher eosinophil counts, baseline oral corticosteroid use and history of nasal polyposis. Patients with those characteristics have been reported to present bigger exacerbation risk reductions as well as FEV1 improvement.”
“Despite the fact that our patient fulfilled all the previous characteristics he was a non-responder, this might be due to the complex physiopathology of the disease and the multiple mechanisms implied,” Celis-Preciado added. “It also calls for further investigations on how to better select patients for each biologic therapy in order to ascertain response.”
