Abstract
Background Three biologics targeting interleukin 5 (anti-IL5) or its receptor-α (anti-IL5Ra) are approved for patients with severe asthma.
Methods We conducted a systematic search until May 1, 2023, to identify observational studies and non-randomised trials that assess the response to anti-IL5/5Rα of real-life patients with severe eosinophilic asthma in MEDLINE and EMBASE. We performed random-effects meta-analyses.
Results We identified 6,401 studies of which 92 with 9546 patients were analysed. Biologics use was associated with 62% reduction in severe exacerbations (risk ratio, RR, 0.38, 95%CI 0.29 to 0.50) and 54% reduction in hospitalisations (RR 0.46, 95%CI 0.35 to 0.61) at 12 months of treatment, compared to pre-treatment. Biologics improved asthma control [decrease in asthma control questionnaire (ACQ) by 1.11 points (95%CI −1.29 to −0.94) and increase in asthma control test (ACT) by 6.41 points (95%CI 5.66 to 7.16)], and increased the asthma quality of life questionnaire (AQLQ) by 1.08 points (95%CI 0.88 to 1.28) and forced expiratory volume in 1 s (FEV1) by 0.21 L (95% CI 0.15 to 0.27) at 12 months. There was a significant reduction in oral corticosteroids use by 51% (RR 0.49, 95%CI 0.42 to 0.56), with a mean dose reduction of 6.01 mg/d (95%CI −7.55 to −4.48) at 12 months of treatment. Similar findings were observed at 3–4, 6 and 24 months. Biomarker-related response to treatment was also noted.
Conclusions This comprehensive meta-analysis summarises the significant clinical response to anti-IL5/5Rα biologics in real-life studies, providing important insights for clinical practice use of these agents.
Footnotes
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Conflict of interest: ST has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from GSK, Astra-Zenecca, ELPEN, and Chiesi and support for attending meetings and/or travel from Astra-Zenecca, ELPEN, and Menarini.
Conflict of interest: AG has received consulting fees from Boehringer Ingelheim and Chiesi and payment or honoraria for lectures, presentations, or educational events from AstraZeneca, Boehringer Ingelheim, Chiesi, ELPEN, GSK, and Novartis.
Conflict of interest: KK has received grants from AstraZeneca, Boehringer Ingelheim, Chiesi, Innovis, ELPEN, GSK, Menarini, Novartis, NuvoAir, consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, ELPEN, GSK, Menarini, Novartis, Pfizer, and Sanofi Genzyme and payment or honoraria for lectures, presentations, or educational events from Alector Pharmaceuticals, AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, ELPEN, Gilead, GSK, Menarini, MSD, Novartis, Pfizer, Sanofi Genzyme, and WebMD, and leadership role with GOLD Assembly.
Conflict of interest: CK, EP, DP, KE, EB, and CA declare no competing interests.
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- Received June 30, 2024.
- Accepted August 22, 2024.
- Copyright ©The authors 2024
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