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Severe Paediatric Asthma Collaborative in Europe: real-world data on children on biologics
Norrice M Liu1, Mariëlle W Pijnenburg2, Antoine Deschildre3
1Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, UK.
Insights
Real-world data shows that many children with severe asthma on biologics still experience exacerbations. Switching between biologic therapies is common, indicating an ongoing need for better treatments for severe paediatric asthma.
Area of Science:
- Pediatric Pulmonology
- Clinical Immunology
- Real-World Evidence Research
Background:
- Severe paediatric asthma lacks comprehensive real-world data, particularly for children on biologic therapies.
- Understanding the characteristics and treatment outcomes of these children is crucial for advancing care.
Purpose of the Study:
- To describe the characteristics of children with severe asthma receiving biologic treatment.
- To assess asthma control, severity, and treatment patterns in this population.
Main Methods:
- The Severe Paediatric Asthma Collaborative in Europe (SPACE) enrolled 250 children with severe asthma on biologics.
- Data collected included demographics, asthma control (GINA criteria), severity indices (CASI), exacerbations, lung function, and quality of life.
- Comparisons between different biologics were adjusted for age, sex, and treatment duration.
Main Results:
- Omalizumab was used by 56.8%, mepolizumab by 21.6%, and dupilumab by 21.6% of children.
- Despite treatment, 27% had partly controlled and 8% uncontrolled asthma (GINA criteria).
- Over 50% experienced at least one exacerbation in the past year, and 10% were hospitalized.
Conclusions:
- Most children on biologics achieved good symptom control, but significant challenges with asthma attacks and control persist.
- A substantial proportion of patients switched biologics, often due to nonresponse.
- There remains a clear unmet need for more effective therapies in severe paediatric asthma.
Introduction:
Real-world data on children with severe asthma is scarce. We report characteristics of children with severe asthma already on biologics, enrolled in the Severe Paediatric Asthma Collaborative in Europe, a clinical research collaboration of the European Respiratory Society.
Methods:
We describe patient's characteristics including asthma control assessed with Global Initiative for Asthma (GINA) criteria, composite asthma severity index (CASI), exacerbations, unscheduled medical attendances, lung function and quality of life in children on biologic treatment because of severe asthma. We also assessed previous biologics use. Forced expiratory volume in 1 s, CASI, GINA, Paediatric Asthma Quality of Life Questionnaire score, exacerbations, unscheduled medical attendance and hospital admission comparisons in patients treated with different biologics were adjusted by age, sex and biologic therapy duration.
Results:
Among the 250 children (median age 13.2 years) recruited, 56.8% used omalizumab, 21.6% mepolizumab and 21.6% dupilumab. At enrolment, the dupilumab group was older (median 15.0 years), while the omalizumab group had been on biologic treatment the longest (median 622 days). Overall, 27% and 8% had partly controlled and uncontrolled asthma respectively, according to GINA. In the last 12 months, 52% and 29% had at least one and two exacerbations, respectively; airflow obstruction was found in 33%. 10% were admitted to hospital due to exacerbation. A previous switch from another biologic was recorded in 16%, predominantly due to nonresponse.
Conclusions:
Most children on biologics obtained good symptom control, but many still experienced asthma attacks. Switching between biologics was substantial. There is still an unmet need in severe paediatric asthma.
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