REVIEW OF BIOLOGIC EFFICACY IN PATIENTS WITH UNCONTROLLED ASTHMA BY AGE AT ASTHMA ONSET

IntroductionAsthma is a heterogenous disease with different mechanisms associated with early-onset asthma (allergic inflammation) and late-onset asthma (eosinophilic inflammation), which can lead to patients’ responses to biologics varying by age at asthma onset. This analysis summarized published annualized asthma exacerbation rate (AAER) reductions from randomized controlled trials (RCTs) in patients with moderate to severe, uncontrolled asthma by age at asthma onset to inform optimal biologic choice.MethodsA systematic literature search was performed in PubMed to identify published data from phase 3 RCTs of US FDA-approved biologics in patients with asthma (no publication date restrictions). Included publications assessed AAER reductions versus placebo in patients by age at asthma onset (<18, 18 to <40 and ≥40 years).ResultsSix publications were included (one each for omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab and tezepelumab). Omalizumab, studied and indicated for allergic asthma, demonstrated a trend of reduced efficacy in patients with asthma onset at ≥40 years of age. Collectively, biologics studied and indicated for eosinophilic asthma (benralizumab, mepolizumab, reslizumab, dupilumab) demonstrated trends of reduced efficacy in younger-onset age groups (<18 years: mepolizumab, benralizumab, dupilumab; <40 years: reslizumab) (Figure). Tezepelumab, studied and indicated for all asthma phenotypes, demonstrated a trend of reduced efficacy in younger-onset patients (<18 years).ConclusionAmong patients with moderate to severe, uncontrolled asthma, biologic efficacy by age at asthma onset aligned with biologic mechanisms of action and indications (allergic vs eosinophilic vs all phenotypes). These differences can help to identify patients more responsive to individual biologics, informing provider treatment decisions.