Suboptimal response to biologics in severe asthma patients with humoral immunodeficiencies

<bold>Background:</bold> Asthmatic patients with antibody deficiencies (AD) have more severe disease and a higher risk of exacerbations. No data exist about the efficacy of biologics in severe asthma (SA) patients with AD. The objective of this study was to evaluate comparatively the efficacy of biologics in SA patients with and without AD. <bold>Methods:</bold> A case-control real-life study was realized including 68 patients divided into two groups: group 1 with SA-AD and group 2 with SA. <bold>Results:</bold> Treatment by biologics for 6 months was effective in decreasing the number of exacerbations, hospitalizations, and emergency department (ED) visits, to improve the Asthma Control Questionnaire (ACQ) score and proved a systemic corticosteroid sparing effect. Despite benefits, the number of exacerbations, hospitalizations, and ED visits, the mean ACQ score, and the cumulative dose of systemic corticosteroids remain higher in group 1 vs 2, with lower lung function parameters. The rates of responses were inferior in group 1 vs 2 with a decrease by ≥50% of exacerbation rate in 76% vs 97% of patients (p=.006), no hospitalization in 44% vs 91% of patients (p<.001), no ED visit 56% vs 82% of patients (p=.018), significant improvement of ACQ score by ≥0.5 in 68% vs 100% of patients (p<.001), an increase of forced expiratory volume in the first second by >10% in 32% vs 65% of patients (p=.007). <bold>Conclusion:</bold> Despite evident benefits, SA patients with AD have suboptimal responses to biologics compared to those immunocompetent. A multidisciplinary approach is necessary to optimize the management of these patients in practice.