Biomarkers on the clinical usage of biologicals in the EAACI
The EAACI recently published the Guidelines on the use of biologicals in
severe asthma. Recommendations were formulated following the GRADE
approach338-340 for each biological (benralizumab,
dupilumab, mepolizumab, omalizumab, reslizumab) and each outcome
(decrease in asthma exacerbations, oral and inhaled corticosteroids and
rescue medication use; improvement in asthma control, quality of life
and lung function; and, safety).33 The recommendations
were informed by 3 systematic reviews.341-343 FeNO,
sputum and blood eosinophils were scored as outcomes with low
importance, however the evidence was analysed for subgroups based on
biomarkers and co-morbidities. The higher the blood eosinophils the
higher the expected impact of benralizumab, dupilumab and mepolizumab in
reducing severe asthma exacerbations. The improvement in asthma control
was significantly better in the high eosinophil subgroup for
benralizumab and reslizumab. Lung function increased significantly more
in the high eosinophil subgroup for benralizumab, dupilumab and
reslizumab. Benralizumab improved QoL better in the high eosinophil
subgroup. The effect of omalizumab on exacerbations did not depend on
blood eosinophils. Neither the atopic status or total IgE predict the
magnitude of effect of benralizumab and serum IgE thresholds (within
regulatory limits) did not influence the response to omalizumab (Table
4).
Table 4. Current biologicals, biomarkers, asthma outcomes and
GRADE recommendation