The perceived waning of biologics in severe asthma

Biologics are highly effective in severe asthma and used at fixed dosing intervals. However, in clinical practice, dosing intervals are sometimes shortened if patients perceive a decreased biologic effect before the next administration. The occurrence and clinical relevance of this perceived waning...

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Bibliographic Details
Published in:	Respiratory medicine Vol. 219; p. 107416
Main Authors:	Kroes, J.A., Van Hal, L.H.G., Van Dijk, L., Zielhuis, S.W., Van Der Meer, A.N., Van Roon, E.N., Ten Brinke, A.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-11-2023
Subjects:	Asthma - diagnosis Biological Products - therapeutic use Biological treatment Cross-sectional studies Humans Patient reported outcome measures Personalized medicine Quality of Life Severe asthma Surveys and Questionnaires Patient reported outcome measures Severe asthma Biological treatment Cross-sectional studies Personalized medicine
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Summary:	Biologics are highly effective in severe asthma and used at fixed dosing intervals. However, in clinical practice, dosing intervals are sometimes shortened if patients perceive a decreased biologic effect before the next administration. The occurrence and clinical relevance of this perceived waning of biological effect is unknown. To explore (1) the frequency, severity and conditions, (2) associated symptoms and (3) relationship with clinical characteristics of the patient-perceived waning effect of biologics before the next administration. Severe asthma patients receiving biological treatment ≥4 months were included. Based on 17 semi-structured patient interviews, we developed a questionnaire focusing on the waning effect of biologics before the next administration, which was distributed among 129 patients. Clinical characteristics, including asthma control (ACQ) and quality of life (AQLQ) scores, were collected from patient files. 65/101 patients who completed the questionnaire reported a waning of biological effect, graded as severe (median (IQR) 6.5 (5–7.5) on a 0–10 BORG-scale). Waning manifested in a broad spectrum of symptoms. Patients reporting waning had higher ACQ and lower AQLQ scores versus those without (p < 0.05) and higher BORG-scores were associated with higher exacerbation rate (ρ = 0.309, p = 0.013). A third of all patients were in favor of extending or shortening their dosing interval. Two-thirds of severe asthma patients report waning of biologic effect at the end of the dosing interval, which is associated with poorer asthma control and quality of life. The diversity in observed waning of effect opens the way for research into more individualized dosing of biologics. •This is the first study focusing on the waning of biologic effect in severe asthma.•Many severe asthma patients experience a waning of biological effect.•Waning manifests in a wide variety of symptoms.•Waning is associated with poorer asthma control and quality of life.•Research into more individualized dosing of biologics is warranted.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0954-6111 1532-3064
DOI:	10.1016/j.rmed.2023.107416