Risk of Respiratory Tract Infections with Asthma Biologics

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.

To characterize the risk of respiratory tract infections associated with using asthma biologics.

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.

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.

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.