D1.109 - Biologics selection algorithm for severe T2-bronchial asthma targeted therapy

The choice of biologic therapy for severe T2-asthma requires a clear phenotypic differentiation to ensure maximum treatment efficacy.

Objective: To develop an algorithm for selecting biologics based on phenotype for the targeted therapy of T2-severe asthma (T2-SA).

The registry of adult patients with T2-SA (2020-2024) receiving targeted therapy was analyzed. Treatment effectiveness was assessed using the BARS (Biologics Asthma Response Score) scale at 4 and 12 months compared to baseline. A direct comparative study was conducted on the efficacy of anti-IgE (omalizumab, n=62) and anti-IL4R (dupilumab, n=33) therapies in patients with allergic SA and mixed (combination of allergic and non-allergic eosinophilic phenotypes) SA. Additionally, a direct comparative study was performed on the efficacy of anti-IL4R (dupilumab, n=30) and anti-IL5 (mepolizumab, n=22) therapies in patients with non-allergic eosinophilic SA.

Patients with allergic SA and mixed SA showed good and satisfactory responses in 88.2% and 86.5% of cases to dupilumab and omalizumab, respectively. Omalizumab proved more effective in allergic SA, while dupilumab was more effective in mixed SA. Patients with non-allergic eosinophilic SA showed good and satisfactory responses in 94.1% and 84.2% of cases to mepolizumab and dupilumab, respectively. A certain efficacy advantage (94.1%) was identified for mepolizumab.

Anti-IgE and anti-IL4R therapies can be interchangeable in patients with allergic SA and mixed SA, with a preferential choice of omalizumab for allergic SA. Anti-IL5 and anti-IL4R therapies can be interchangeable in patients with non-allergic eosinophilic SA, with a preferential choice of mepolizumab. Dupilumab can be the drug of choice for allergic, non-allergic eosinophilic and mixed SA.