Biologics in Severe Eosinophilic Asthma: Three-Year Follow-Up in a SANI Single Center

Paolo Solidoro, Stefania Nicola, Irene Ridolfi, Giorgio Walter Canonica, Francesco Blasi, Pierluigi Paggiaro, Enrico Heffler, Diego Bagnasco, Filippo Patrucco, Fulvia Ribolla, Caterina Bucca, Giovanni Rolla, Carlo Albera, Luisa Brussino

Research output: Contribution to journalArticlepeer-review


Introduction: Biologic drugs have dramatically improved severe eosinophilic asthma (SEA) outcomes. Our aim was to evaluate the long-term efficacy of biological therapy in SEA in a real-life setting and to identify the predictors for switching to another biological drug in patients with poor asthma control. The outcomes for efficacy were decreased annual exacerbations (AE) and improved asthma control test (ACT). Methods: In 90 SEA patients being treated with a biological drug, clinical examination, ACT, blood eosinophils count and spirometry were assessed before (T0) and after 6 (T1), 12 (T2), 24 (T3) and 36 (T4) months from the start of biological therapy. Patients were considered responders (R) or non-responders (NR) to biologics depending on whether or not they had less than two AE and a 20% increase in the ACT after 12 months of treatment. Results: 75% of the patients were R, 25% NR. In R patients, biological therapy add-on was followed by significant improvement in AE and ACT throughout the whole follow-up period. The percentage of patients on oral corticosteroids (OCS) dropped from 40% to 12%. By contrast, the NR patients were shifted to another biological drug after 12 months of therapy, as they still had high AE and nearly unchanged ACT; 40% of them still needed OCS treatment. The predictors of switching to another biological drug were three or more AE, ACT below 17, nasal polyposis and former smoking (p < 0.05). In NR, the shift to another biological drug was followed by a significant decrease in AE and an increase in the ACT. Discussion: This real-life study confirms the long-term efficacy of biologics in most SEA patients and indicates that even in non-responders to a first biological drug, it is worth trying a second one. It is hoped that the availability of additional biologics with different targets will help improve the personalization of SEA therapy.

Original languageEnglish
Article number200
Issue number2
Publication statusPublished - Feb 2022


  • ACT
  • Benralizumab
  • Biologics
  • Dupilumab
  • F NO
  • IL-13
  • IL-4
  • IL-5
  • Lung function tests
  • Mepolizumab
  • Omalizumab
  • Real-life setting
  • SANI registry
  • Severe eosinophilic asthma
  • T2-high asthma

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Biochemistry, Genetics and Molecular Biology(all)


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