A real-world evaluation of clinical outcomes of biologicals and bronchial thermoplasty for severe refractory asthma (Bioterm)

Francesco Menzella, Matteo Fontana, Carla Galeone, Maria D’Amato, Giorgio Walter Canonica, Giulia Ghidoni, Silvia Capobelli, Chiara Scelfo, Anna Simonazzi, Chiara Catellani, Patrizia Ruggiero, Nicola Facciolongo

Research output: Contribution to journalArticlepeer-review


Background: The important progress made on asthma phenotyping encouraged the development of new therapeutic strategies, such as monoclonal antibodies (mAbs) and bronchial thermoplasty (BT). The aim of this study is to compare patients diagnosed with severe refractory asthma (SRA) who are currently being treated with omalizumab, mepolizumab, benralizumab or BT and to evaluate the efficacy of these treatments over a 12-month observation period. Methods: Overall, 199 consecutive patients with SRA were included. The cohort was selected referring to the eligibility criteria for all available biologics and BT. Results: Among 32 patients treated with benralizumab, we found a 16.7% reduction in hospitalizations, a 66.6% reduction in exacerbations (p = 0.0001) and the greater improvement in FEV1 (+ 37.4%, p < 0.0001). Among omalizumab group (54 patients), there was a 85.7% (p = 0.012) reduction in hospitalizations and a 88.8% (p < 0.0001) reduction in exacerbations. In the mepolizumab group (83 patients), we found a 89.5% (p = 0.02) reduction in hospitalizations and a 92.1% (p < 0.0001) reduction in exacerbations. BT subgroup (30 patients) showed a 93.7% (p = 0.001) reduction in hospitalizations and a 73.5% (p < 0.0001) reduction in exacerbations. The best results in terms of OCS sparing effect were obtained by BT (- 76%, p < 0.0001) and mepolizumab (- 90.2%, p = 0.002). Omalizumab showed the highest percentage of super responder patients. Conclusion: To our knowledge, this is the first study to compare all marketed mAbs with BT, ending in more comprehensive and applicable results to clinical practice. All biologics, to varying degrees, reduced hospitalizations, exacerbations, and OCS use. The starting point for patients in the BT group was worse regarding hospitalizations, exacerbations and OCS, but despite this, even this non-pharmacological option obtained positive results, comparable to biologics.

Original languageEnglish
Pages (from-to)1019-1031
Number of pages13
JournalJournal of Asthma and Allergy
Publication statusPublished - 2021


  • Biologics
  • Bronchial thermoplasty
  • Exacerbations
  • Oral corticosteroids
  • Severe asthma

ASJC Scopus subject areas

  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine


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