Which Biologics Reduce Allergic Response, Airway Hyperresponsiveness in Asthma?

Among patients with asthma, early and late allergic responses were reduced with omalizumab and tezepelumab, according to systematic review findings presented at the American Thoracic Society (ATS) International Conference 2022 held in San Francisco, CA, May 13 to 18. Nonspecific airway hyperresponsiveness to methacholine or mannitol was also reduced by tezepelumab.

Airway hyperresponsiveness (AHR) results when an allergen (such as metacholine or mannitol) causes an inflammatory response that includes enhanced bronchoconstriction, noted study authors. To better understand how airway inflammation affects AHR and the progression of asthma, researchers for the current study sought to investigate the effects of biologic treatments on AHR and early and late allergic responses.

To accomplish this, the investigators conducted a retrospective systematic review of 22 randomized controlled trials of biologics for asthma treatment conducted between January 1997 and October 2021, examining the effect of these therapies on allergic response or AHR. The studies included biologics that were approved, non-approved and discontinued.

The researchers found 6 studies that discussed the effects of omalizumab in reducing early allergic responses (EAR), late allergic responses (LAR), and AHR to methacholine or acetylcholine tests. In a single study, tezepelumab reduced EAR and LAR; in 1 study tezepelumab reduced AHR to methacholine, and in 2 studies to mannitol. A few studies showed no effect of mepolizumab on EAR, LAR, or AHR. A single study on each of IMA-638, lebrikizumab, and tralokinumab revealed no effect on AHR. Single studies showed etanercept reduced AHR, benralizumab did not affect LAR, and efalizumab, tocilizumab, Ro-24-7472, and anti-OX40 ligand all were without effect on AHR. A single study showed pitrakinra had no effect on AHR but reduced LAR. No results were found for dupilumab or reslizumab.

Researchers concluded, “reductions in both EAR and LAR to allergens were observed with omalizumab and tezepelumab. Tezepelumab also consistently attenuated nonspecific AHR to methacholine or mannitol.” They believe their study suggests that, “tezepelumab may broadly target mediators or cells involved in asthma inflammation.”

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