Never smokers, ex-smokers see similar positive asthma outcomes with biologics

The benefits of 52-week biologic therapy on asthma control and lung function are observed in both never smokers and ex-smokers with severe asthma, according to data published in The Journal of Allergy and Clinical Immunology: In Practice.

“Ex-smokers with severe asthma may be eligible for biologics as well as never-smokers and should be included in randomized trials,” Slagjana Stoshikj, MD, attending physician at the Medical University of Vienna, and colleagues wrote.

Using the German Asthma Net registry, Stoshikj and colleagues evaluated 1,129 patients (mean age, 53.82 years; 55.8% women) with severe asthma to determine how changes in asthma control, lung function, exacerbation rate and daily oral prednisolone use after 52-week biologic therapy differ based on ex-smoker status (44%) vs. never smoker status (56%).

Notably, the ex-smoker group included 22.9% of patients with less than 10 pack-years, 10.3% with 10 to 20 pack-years and 10.6% with greater than 20 pack-years, according to the study.

Benralizumab (Fasenra, AstraZeneca) was the biologic received by the greatest proportion of patients in this study population (38.3%), followed by dupilumab (Dupixent; Sanofi, Regeneron; 28.9%), mepolizumab (Nucala, GSK; 18.3%), omalizumab (Xolair; Novartis, Genentech; 14%) and reslizumab (Cinqair, Teva Pharmaceuticals; 0.5%).

When compared with the never smoker cohort, the ex-smoker cohort had similar improvements in asthma control, lung function, exacerbation rate and daily oral prednisolone dose. Researchers reported that this finding was based on each of these factors not differing significantly between the groups at the 52-week mark.

This outcome held true across three asthma control assessments (Asthma Control Test, Asthma Control Questionnaire-5 and mini-Asthma Quality of Life Questionnaire), as well as four lung function measures (FEV1, FVC, peak expiratory flow and mean expiratory flow 50), according to the study. For example, FEV1 went up by 16% among never smokers and 18% among ex-smokers. For FVC, researchers reported an 8% rise among never smokers and a 12% rise among ex-smokers.

In addition to the above factors, researchers analyzed fraction of exhaled nitric oxide (FeNO) and blood eosinophil count. Similar to above, both measures improved in ex-smokers and never smokers at the 52-week mark, with no significant differences found between the two cohorts. For example, FeNO dropped by 0.69 parts per billion from the baseline value of never smokers and 0.64 parts per billion from the baseline value of ex-smokers.

“This study offers valuable insights into biological treatment outcomes for patients with a smoking history and characterizes a specific population of individuals with severe asthma who can benefit from this therapy,” Stoshikj and colleagues wrote. “This might help identify patients for upcoming severe asthma trials and clarify the smoking impact on asthma, particularly regarding T2-inflammation.”