Comparative Responses to Biologic Therapies in Moderate-to-Severe Pediatric Asthma
Abstract
Introduction:
Among pediatric patients with moderate to severe persistent asthma, a subset of children continues experiencing poorly controlled asthma symptoms despite receiving standard treatment. Such patients may be eligible to receive biologic therapies for add-on asthma control; however, research on their real-world use and outcomes in the pediatric population is lacking. This study aims to assess pediatric patient responses to biologic therapy, reasons for discontinuing therapy, and changes in symptom control for patients who switched biologics.
Methods:
Retrospective chart review of pediatric patients on omalizumab, mepolizumab, and dupilumab for moderate or severe persistent asthma was performed. Pulmonary function (forced expiratory volume in one second [FEV1]) and quality of life (asthma control test [ACT]) measures, as well as the number of emergency department (ED) visits, urgent care visits, hospitalizations, asthma exacerbations, and oral corticosteroids used were collected from 12 months before to 12 months after the start of biologic therapy.
Results:
115 patients were included in the study, with the majority (91%) diagnosed with severe asthma. Among participants with severe asthma, FEV1 measures and ACT scores increased significantly by 6 months post-therapy from baseline (p=0.014 and p=0.036, respectively). Additionally, the number of asthma exacerbations, ED visits, and oral steroids received significantly decreased from 12 months prior to 12 months after starting therapy among severe asthmatics (p<0.001). Among those with moderate asthma, there was no significant difference in FEV1 measures; ACT scores; or the number of exacerbations, ED visits, or oral steroids received before starting therapy and 12 months post-therapy (all p>0.05). There was no significant difference in the number of urgent care visits or hospitalizations overtime among moderate (all p>0.05) or severe (all p>0.05) asthmatics. Of the 115 patients enrolled, 30 patients (26.1%) stopped after at least one year of treatment for varying reasons (adverse effects, transportation or cost barriers, lack of improvement).
Conclusion:
Biologic therapy shows benefits in pediatric patients with severe asthma, demonstrating improvements in spirometry and quality of life and reductions in ED visits, asthma exacerbations, and oral steroid use within a year of starting therapy.