B32-38 Identification of Clinical Indicators for Optimal Selection of Biologics in Severe Asthma

Abstract Rationale Five biologic agents are currently available for severe asthma, but no clinical indicators have been established to predict which biologic provides the best response (BR) at initial treatment. We aimed to identify clinical characteristics associated with achieving BR. Methods We retrospectively analyzed 81 patients with severe asthma who received biologics at our institution. The BR biologic was defined according to Global Evaluation of Treatment Effectiveness (GETE) score, and patient characteristics were compared across biologic groups. Results The distribution of BR biologics was: dupilumab 30.9% (n = 25), tezepelumab 18.5% (n = 15), mepolizumab 17.3% (n = 14), benralizumab 11.1% (n = 9), and omalizumab 6.2% (n = 5); 16.0% (n = 13) did not achieve BR. Patients for whom omalizumab was identified as the BR biologic more frequently had seasonal allergic rhinitis, preserved lung function, and lower eosinophil counts and FeNO levels. The mepolizumab/benralizumab BR group had a higher prevalence of hypertension, lower lung function, and higher eosinophil counts. The dupilumab BR group was characterized by younger age and multiple type 2 inflammation-related comorbidities, such as allergic rhinitis (AR), atopic dermatitis (AD), and chronic rhinosinusitis (CRS). The tezepelumab BR group mainly included adult-onset asthma with low type 2 biomarkers. Patients who did not reach BR tended to have early-onset disease, a higher smoking index, low FeNO, and poor lung function. Conclusions Distinct clinical characteristics were associated with each BR biologic. Considering these indicators may help predict the optimal initial biologic therapy for patients with severe asthma. This abstract is funded by: None