Real-world comparison of T2-biologics effectiveness in severe allergic asthma with nasal polyps
(2025) Respiratory Medicine — Vol. 238, p. 107979 (2025)
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- Authors
Migueres, Nicolas 
Gonzalez-Barcala, Francisco-Javier
- Abstract
- Background: Patients with severe allergic asthma (SAA) and blood eosinophil count ≥0.3x10 9 /L are eligible for multiple biologics. Several of them showed benefits on nasal polyps (NP), a frequent comorbidity of the severe asthma, but comparative studies on their effectiveness in the association SAA-NP are currently lacking. Our objective: was to compare the effectiveness of anti-IgE, anti-IL5/R and anti-IL4R in patients with SAA-NP in real-world settings. Methods: A real-world multicentre observational study was realized including patients with SAA-NP treated by anti-IgE, anti-IL5/R or anti-IL4R for 6 months. We analyzed the nasal and respiratory symptoms, the number of asthma attacks and salbutamol use/week, acute sinusitis and severe exacerbation rates, the asthma control score, the lung function parameters, the NP endoscopic score, the sinus imaging, and the blood eosinophil count 6 months before and after treatment. Results: One hundred seven patients with SAA-NP were included: 35 treated by anti-IgE, 38 by anti-IL5/R and 34 by anti-IL4R. All the biologics showed similar effectiveness in improving asthma outcomes (symptoms, exacer-bation rate, asthma control, lung function). Despite the amelioration of almost all rhinological parameters and sinus imaging in each group, greater benefits were found in the anti-IL4R group in terms of loss of smell (odds ratio OR 3.64[1.3-11.1], p = 0.017), nasal obstruction (OR12.00[2.00-23.10], p = 0.023), and NP endoscopic score (OR 18.10[4.43-24.50]). Conclusion: All three biological classes improved asthma and sino-nasal outcomes in patients with SAA-NP. However, anti-IL4R was superior in improving the smell, nasal obstruction, and NP endoscopic size. Larger comparative studies are needed to confirm our results.
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Citations
Tiotiu-Cepuc, I., Migueres, N., Gonzalez-Barcala, F.-J., Roux, P., Oster, J.-P., Moutard, N., De Blay, F., & Bonniaud, P. (2025). Real-world comparison of T2-biologics effectiveness in severe allergic asthma with nasal polyps. Respiratory Medicine, 238, 107979. https://doi.org/10.1016/j.rmed.2025.107979 (Original work published 2025)