High degree of remission in pediatric severe asthma patients treated with biologics in a real-world setting.

BACKGROUND: Asthma is the most common chronic disease in childhood and although many children with asthma achieve disease control with low- to medium-dose inhaled corticosteroids, 2-10% have severe asthma (SA). Biologics have been available for treatment in adults and adolescents for almost twenty years, and currently 5 biologic therapies have been approved by regulatory agencies for SA in children and/or adolescents. OBJECTIVE: To describe the evolution and remission rate of pediatric SA patients on biologics, including after switch of biologic. METHODS: A retrospective observational study was conducted January 2023 to January 2024 in SA children (6-18 years) in a tertiary care hospital. American Thoracic Society/European Respiratory Society (ATS/ERS) criteria classified asthma as severe. Patients who started biologic therapy, or who switched from a previous biologic, were included. Index date is the timepoint at which biologic therapy was started or switched. We compare clinical and biomarker (fractional exhaled nitric oxide, blood eosinophil count [BEC], IgE) data from 12 months pre- with 12 months postindex- date. RESULTS: Sixty children were included (mean age 14.1 ± 3.2 years); 34/60 (56%) female. Our 46 biologic-naïve patients received omalizumab in 21/46 (46%), dupilumab in 23/46 (50%), and mepolizumab in 2 (4%). Fourteen switchers (23%), who presented incomplete improvement on their first biologic, were changed to a second/third biologic including benralizumab and tezepelumab. Our children experienced an average of 2.4 severe exacerbations 12 months pre-index date. Twelve months post-index-date, no child experienced severe exacerbations and 98% (59/60) reached complete, 4- parameter, clinical remission plus a significant reduction of all biomarkers. CONCLUSION: The use of biologic therapies in pediatric patients with SA allowed for adequate disease control. With correct biologic selection or timely switch when incomplete response, clinical remission, normalization of lung function and a reduction in ICS daily dose was achieved in a very high percentage. Moreover, controlling asthma enables allergen-specific immunotherapy for children with allergic SA.