Unmet needs due to severe asthma have been one of the leading themes throughout the 57th National Congress of the Spanish Society of Pulmonology and Thoracic Surgery (Separate). In this Saturday session we analyzed what to do when a biologic for asthma, monoclonals, and secondary failure fail. One of the main conclusions drawn from the day was that when biological treatment fails, it is necessary to “evaluate the therapeutic adherence, evaluate comorbiditiescharacterize the causes of exacerbations, reevaluate the inflammatory phenotype and ultimately assess whether a therapeutic change is necessary.”
Vicente Plazadirector of the Pulmonology Service of the Sant Pau Hospital, explained that when analyzed carefully, the response of biological treatments is very varied.” After analyzing a group of patients in a study, the specialist has recognized that “only 15 percent of them manage to progress with perfect answerswhile the rest does not work or works partially, achieving a non-optimal response to asthma.”
=”600″ height=”240″ layout=”responsive” alt=”AMP”> Vicente Plaza, director of the Pulmonology Service at the Hospital de Sant Pau. |
Given this scenario, one of the conclusions that Plaza has reached is that “prescribers always consider a therapeutic change in the face of these bad results. This change is too fast, so something else must be done and keep investigating the reason for the failure of biological treatments.”
| Plaza: “Prescribers always consider a therapeutic change in the face of these poor results” |
To break this dynamic, a group of specialists together with Plaza decided to make a literature review to know what the causes of therapeutic failure are, managing to find different aspects divided into the following causes described by the pulmonologist: “There is a incorrect identification of high T2there are different T2 mechanisms involved, there are changes in the inflammatory phenotype, insufficient doses of the biological, autoimmune phenomena, infections, comorbidities and less therapeutic adherence.
When the biological fails, the specialist has defended the need to “evaluate the therapeutic adherence, evaluate comorbiditiescharacterize the causes of exacerbations, reevaluate the inflammatory phenotype and assess whether a therapeutic change is necessary.”
Monoclonals and secondary failure in exacerbations
Analyzing the different complete responses in a patient has been the responsibility of Luis Perezhead of the Service Lucus Augusti Hospital of Lugo: “Depending on the specialist, there are different levels of demand that can be tolerated, generating different definitions of response. The full rate is not achieved by most patients.”
One of the aspects that the pulmonologist wanted to address is the fact that some patients “lose response over time. There is no data on what types of patients this happens to.” When defining this secondary failure, the specialist has made it clear that it is not easy, although “there has to be a primary response. “The patient who needs corticosteroids again means a failure, but if only one aspect such as spirometry deteriorates, doubts are raised.”
=”600″ height=”240″ layout=”responsive” alt=”AMP”> Luis Pérez, head of the Lucus Augusti Hospital Service in Lugo. |
| Pérez: “There has to be a primary response to identify a secondary failure” |
In relation to exacerbations, the pulmonologist explained that, although there is not much data, “they can be divided into three groups of patients. In 21 percent, exacerbations are frequent, 41 percent have never suffered them and 38 percent are the ones who have intermittence”. The influence of future exacerbations is linked to an increased risk of having “history of exacerbationsthe use of macrolides and the chronic rhinosinusitis. On the other hand, the risk is lower in the male sex, the use of biologicals and the symptoms controlled.”
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