Comparative analysis of biologics' effects on lung function parameters in severe asthma.

Background: Different biologics available as add-on treatment for severe asthma (SA) showed modest benefits on lung function parameters but head-to-head comparisons are lacking.

Objective: This study aims to compare the effects of four biologics on lung function parameters (including small airways) at 6 and 12 months of treatment in patients with SA.

Methods: An observational multicenter study was conducted on adults patients with SA naïve to biologics treated by benralizumab, dupilumab, mepolizumab and omalizumab with lung function assessment by spirometry and gas dilution method at baseline (T0), after 6 (T6) and 12 months (T12) of treatment.

Results: One hundred fifty-eight included patients were divided into four groups: 41 patients treated with omalizumab, 41 patients with mepolizumab, 36 patients with benralizumab, and 40 patients with dupilumab. Most lung function parameters were improved after 6 and 12 months of treatment without significant differences between groups except for the changes in the forced expiratory volume in one second in % (ΔFEV1%) (5.8±15.2 vs. 10.3±10.8 vs. 14.3±15.3 vs. 11.8±14.6, p=0.025) and forced vital capacity in % (ΔFVC%) (3.0±15.6 vs. 6.7±14.6 vs. 13.6±14.7 vs. 8.4±14.9, p=0.014) at T6, higher in the group receiving benralizumab. Trends for greater effectiveness of dupilumab in improving small airway dysfunction and benralizumab on distal airway obstruction were noted but the results are not always significant.

Conclusion: All four biologics showed comparable effectiveness in the improvement of lung function parameters after 6 and 12 months of treatment, except the changes of FEV1 and FVC in % at T6 in favor of benralizumab.