Efficacy and Safety of Biologics for Oral Corticosteroid–Dependent Asthma: A Systematic Review and Network Meta-Analysis
Issued Date
2023-01-01
Resource Type
ISSN
22132198
Scopus ID
2-s2.0-85178579506
Pubmed ID
37972921
Journal Title
Journal of Allergy and Clinical Immunology: In Practice
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Allergy and Clinical Immunology: In Practice (2023)
Suggested Citation
Phinyo P., Krikeerati T., Vichara-Anont I., Thongngarm T. Efficacy and Safety of Biologics for Oral Corticosteroid–Dependent Asthma: A Systematic Review and Network Meta-Analysis. Journal of Allergy and Clinical Immunology: In Practice (2023). doi:10.1016/j.jaip.2023.11.007 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/91483
Title
Efficacy and Safety of Biologics for Oral Corticosteroid–Dependent Asthma: A Systematic Review and Network Meta-Analysis
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Background: A maintenance oral corticosteroid (OCS) in addition to high-dose inhaled corticosteroids plus long-acting β2-agonists in patients with severe asthma leads to long-term adverse events. Oral corticosteroid–sparing agents are of high priority. Objective: This network meta-analysis assessed biologics' comparative efficacy and safety in OCS-dependent patients with asthma. Methods: We performed a systematic search through PubMed, Scopus, Embase, the Cochrane Center of Controlled Trials, and Google Scholar for randomized controlled trials that addressed the efficacy and safety of biologics compared with placebo in OCS-dependent patients with asthma from inception to July 2023. The primary outcome was an overall reduction in the OCS dose while asthma control was maintained. Results: We included seven randomized controlled trials involving 1,052 OCS-dependent patients with asthma. Compared with placebo, benralizumab every 8 weeks, benralizumab every 4 weeks, dupilumab, and mepolizumab were efficacious in achieving a reduction in the OCS dose with low to moderate confidence (odds ratio [95% CI]: 4.12 [2.22-7.64]; 4.09 [2.22-7.55]; 3.25 [1.90-5.55]; and 2.39 [1.25-4.57], respectively) whereas tralokinumab, tezepelumab, and subcutaneous reslizumab were ineffective. An indirect comparison found no significant differences among benralizumab, dupilumab, and mepolizumab. Efficacy in reducing exacerbations was consistent with the primary analysis. High baseline blood eosinophil counts benefit from anti–IL-5 therapies, whereas high FeNO levels favor dupilumab regardless of blood eosinophil counts. Adverse events between biologics and placebo were comparable, except for eosinophilia with dupilumab. Conclusions: In OCS-dependent patients with asthma, benralizumab, dupilumab, and mepolizumab were superior to placebo in reducing the OCS dose. Evaluating baseline biomarkers helps in choosing the proper biologics to maximize treatment effects.