Combining Dual Biologics Therapy for Severe Asthma: A Series of Ten Cases

Yan Chen,* Lu Wang,* Jiaxing Xie Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiaxing Xie, Department of pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 28, Middle Qiaozhong Road, Liwan District, Guangzhou, Guangdong Province, 510163, People’s Republic of China, Tel +86 020 81568591, Email [email protected]: Biologic therapy has revolutionized the management of severe asthma, but a subset of patients with severe asthma exhibits symptoms inadequately controlled by monotherapy, potentially due to the involvement of multi-type 2 pathways. Dual biologic therapy has emerged as a promising strategy, but its efficacy and safety are not yet fully understood.Objective: To describe the characteristics, endotyping features, decision-making process and therapeutic response of patients with severe asthma on dual biologic therapy in a real-world setting.Methods: We present ten patients on dual biologics for severe asthma. The biologic combinations include mepolizumab+ dupilumab (n=7), benralizumab+dupilumab (n=1), omazulab+mepolizumab (n=2). Therapeutic response was assessed by type 2 inflammation biomarkers, symptom control, frequency of acute exacerbations, daily oral corticosteroid (OCS) dosage and side effects.Results: In our 10 cases, six of them are women, the mean age was 56± 15 years old. The mean duration of combination therapy use was 13.5 months (range from 4 to 36 months). Dual biologic therapy was initiated because of inadequate asthma control (N1, N2, N6), poor control of comorbidities (N5, N7, N8, N9) or anti-IL4/13R-induced hypereosinophilia (N3, N4, N5, N7, N10) when treated with a single biologic agent. All ten patients exhibited good tolerance to the combined biologic therapies, leading to improvements in asthma and comorbidity management, and a reduction in OCS usage. No serious adverse events were reported.Conclusion: Dual biologics have been shown to be both effective and safe. However, more studies are needed to fully assess the long-term benefits and potential risks of different combinations of biologic treatments.Keywords: severe asthma, biologic therapy, dual therapy, combination therapy, monoclonal antibody