Effects of biologics in obese severe asthmatic patients

<bold>Background:</bold> Obesity is a common risk factors associated with severe asthma. Few studies have evaluated the effects of biological therapy in severe asthmatic obese patients (OB) in comparison with non-obese patient (NOB). <bold>Aim:</bold> To evaluate clinical, functional, inflammatory, characteristics of the two groups (OB vs NOB) after 6 months of biological treatment in naive severe asthma patients. <bold>Methods:</bold> Severe asthmatics first time treated with anti-IL5/IL5R, anti-IgE, and anti IL-4R were evaluated retrospectively. The population was divided in two groups: OB with BMI >30 and NOB with BMI ≤30. Clinical, functional and inflammatory variables were compared at T0. The effects of biologics were evaluated separately in the two groups at T6. <bold>Results:</bold> Among 93 patients enrolled, 19 (20.4%) were obese. At T0 there are no significant clinical differences between the two groups. At T6 BMI did not change significantly in OB and NOB. A significant improvement of symptoms control (ACT, ACQ) and a reduction of exacerbations was observed in both groups (p<0.001, p<0.001, p<0.001 for NOB and p<0.003, p= 0.010, p<0.001 for OB respectively). FEV1%, FVC%, FEF25-75% increased significantly at T6 in NOB (p<0.001), while FEF25-75% increased significantly in OB patients (p=0.013). Blood eosinophils count (BEc) was significantly reduced in both groups (p<0.001 and p=0.003). Instead, sputum eosinophil percentage (SE%) was significantly reduced only in NOB patients (p=0.002 vs p=0.069). <bold>Conclusion:</bold> Biologics improve clinical outcomes in both groups. OB patients did not achieve the same outcomes as NOB patients. Persistent bronchial inflammation and lack of lung function improvement in OB patients highlight the importance of phenotyping these patients.