Risk of Respiratory Tract Infections with Asthma Biologics.

BACKGROUND: Asthma biologics may increase infection risk due to the role of type-2 (T2) pathways in immune homeostasis. While clinical trials have demonstrated favorable safety profiles, limited real-world data exists to support these findings. OBJECTIVE: To characterize the risk of respiratory tract infections associated with using asthma biologics. METHODS: This retrospective matched cohort study utilizing the TriNetX US Collaborative Network, a multicenter database of electronic health records, examined patients (age ≥6 years) with moderate-to-severe asthma who had exposure to an asthma biologic against controls without such exposure. Study cohorts were followed for up to 2 years and survival analysis contrasted the probability of developing various respiratory tract infections. The hazards ratio (HR) quantified the magnitude and direction of this interaction. RESULTS: As compared to matched controls, exposure to any asthma biologic was not associated with increased hazards of developing respiratory tract infections and lower probabilities of developing influenza (HR 0.80, 95% CI=0.69-0.94) and acute upper respiratory tract infections (URIs) (HR=0.93, 95% CI: 0.87-0.99). Dupilumab exposure was associated with lower probability of developing acute URI (HR=0.79, 95% CI: 0.69-0.91), pneumonia (HR=0.72, 95% CI: 0.58-0.90), and influenza (HR=0.53, 95% CI: 0.36-0.80). Anti-IL5 users had relatively fewer acute URIs (HR=0.88, 95% CI: 0.79-0.97). There was no significant difference in respiratory tract infection risk associated with omalizumab or tezepelumab exposure. CONCLUSIONS: Although further studies focusing on specific pathogens and pathways are needed, asthma biologics are not associated with a higher risk of respiratory infections. Dupilumab might reduce the risk of certain respiratory tract infections.