D1.151 - Changes in Treatment Steps After Biological Therapy in Patients with Severe Asthma: Real-World Data

Severe asthma is a heterogeneous disease that may remain inadequately controlled despite high-dose inhaled corticosteroids (ICS) and additional controller therapies, leading to significant morbidity. Biological agents such as omalizumab, mepolizumab, and benralizumab have been shown to reduce exacerbation frequency and improve disease control. However, real-world data regarding the continuation or step-down of inhaled controller therapies (such as ICS/LABA and LAMA) after initiation of biological treatment are limited. In this study, we aimed to evaluate the changes observed in asthma treatment after the initiation of biological therapy in patients with severe asthma and to assess whether these changes differ according to the type of biological agent used.

In this retrospective study, a total of 81 patients diagnosed with severe asthma who were initiated on omalizumab, mepolizumab, or benralizumab treatment were included. Asthma controller therapies used by the patients before and after biological treatment were recorded by reviewing patient prescriptions and outpatient clinic notes. Treatment changes were categorized as any treatment step-down, reduction in ICS dose, discontinuation of LAMA, and discontinuation of montelukast. Categorical variables were compared according to the type of biological agent used. Chi-square and Fisher’s exact tests were used for statistical analyses, and a p value <0.05 was considered statistically significant.

Among the 81 patients, 49.4% experienced a reduction in any component of asthma treatment after biological therapy, including ICS dose reduction, discontinuation of LAMA, or complete cessation of treatment. The rate of treatment step-down was 67.7% in the omalizumab group, 31.8% in the mepolizumab group, and 42.9% in the benralizumab group, with a statistically significant difference among the groups (p = 0.025). ICS dose reduction was more frequent in patients receiving omalizumab (64.5%) compared with the other groups, and this difference was statistically significant (p = 0.014). The rate of LAMA discontinuation was 51.6% in the omalizumab group, whereas it was 13.6% and 21.4% in the mepolizumab and benralizumab groups, respectively (p = 0.005). Montelukast discontinuation rates did not differ significantly according to the biological agent used (p = 0.224).

In this real-world study, it was demonstrated that inhaled controller therapies could be reduced after the initiation of biological treatment in patients with severe asthma, and that this effect varied according to the biological agent used. Notably, patients receiving omalizumab had higher rates of both ICS dose reduction and LAMA discontinuation. In contrast, no significant difference was observed in montelukast use among the biological agents. Although the study has major limitations, such as its retrospective design and the collection of data from the prescription system and hospital database, the results suggest that re-evaluation of inhaled treatment steps after biological therapy may be feasible and safe in clinical practice.