Combining Dual Biologics Therapy for Severe Asthma: A Series of Ten Cases

Background: Biologic therapy has revolutionized the management of severe asthma, but a subset of patients with severe asthma exhibits symptoms inadequately controlled by monotherapy, potentially due to the involvement of multi-type 2 pathways. Dual biologic therapy has emerged as a promising strategy, but its efficacy and safety are not yet fully understood. Objective: To describe the characteristics, endotyping features, decision-making process and therapeutic response of patients with severe asthma on dual biologic therapy in a real-world setting. Methods: We present ten patients on dual biologics for severe asthma. The biologic combinations include mepolizumab+ dupilumab (n=7), benralizumab+dupilumab (n=1), omazulab+mepolizumab (n=2). Therapeutic response was assessed by type 2 inflammation biomarkers, symptom control, frequency of acute exacerbations, daily oral corticosteroid (OCS) dosage and side effects. Results: In our 10 cases, six of them are women, the mean age was 56±15 years old. The mean duration of combination therapy use was 13.5 months (range from 4 to 36 months). Dual biologic therapy was initiated because of inadequate asthma control (N1, N2, N6), poor control of comorbidities (N5, N7, N8, N9) or anti-IL4/13R-induced hypereosinophilia (N3, N4, N5, N7, N10) when treated with a single biologic agent. All ten patients exhibited good tolerance to the combined biologic therapies, leading to improvements in asthma and comorbidity management, and a reduction in OCS usage. No serious adverse events were reported. Conclusion: Dual biologics have been shown to be both effective and safe. However, more studies are needed to fully assess the long-term benefits and potential risks of different combinations of biologic treatments.