A summary of research led by the European Lung Foundation and published in the European Respiratory Journal
New treatments called biological therapies are now available to treat severe asthma. But there is not yet a standard way of measuring whether a treatment works for a person with severe asthma. Different research teams and health professionals use different ways to test how a person responds to treatment. This makes it difficult to compare different biological therapies. It is also hard to predict if certain groups of patients will be more likely to respond to a treatment.
A group of healthcare professionals, patients, researchers and people involved in developing medicines have come together to create a standard definition. This definition will explain what it means to respond or not respond to biological therapy for severe asthma. Researchers will use the definition in future research studies to test how effective biological therapies are at treating severe asthma.
What did the study look at?
To develop a definition of whether or not a person responds to biological therapy, the team gathered the views of people with severe asthma. This helped to understand their experiences of how they responded to biological therapy. The team thoroughly reviewed previous research to identify patients’ opinions about this topic. They also looked at online discussion forums, blogs and social media websites where people with severe asthma shared their experiences of biological therapy. Researchers were interested in the experiences of adults, teenagers and children with severe asthma and of their parents and loved ones, but it was only possible to find patient experiences from adults.
What do the results show?
Some people with severe asthma described a positive response to biological therapy. They found that it reduced the burden of living with severe asthma and the impact of ongoing asthma treatment. From patients’ perspectives, many different elements contribute to a positive response and may include:
Reducing or stopping oral corticosteroids, such as prednisone, was especially important to people with severe asthma as a sign of a positive response to treatment. When thinking about how to define their response to a biological therapy, patients consider the activities that are meaningful to them – for example being able to:
Some patients had experienced a positive response to biological treatment, but this then reduced over time. They described this as the medications having stopped working, plateauing or they noticed a gradual increase in symptoms. This experience can make the person feel even worse. Some patients feel a level of hopelessness and worry that biological therapies would become less effective over time. Others remain hopeful of new research discoveries. They are willing to stop treatments that are not working so that they can go through more tests or try other options.
In the previous research, most patients responded to biological treatment to some extent. However, some patients only experienced a small improvement or no improvement at all. This usually meant frequent trips to the hospital and needing to take regular oral corticosteroids. A small or no response to biological treatment can negatively affect a person’s mental health.
Some people with severe asthma felt it was important for a biological treatment to work quickly. This affected how well they thought they responded to the treatment. Patients may also factor in treatment cost, travel distance to receive treatment, frequency of injections and the length of time needed for health appointments when considering their response to treatment.
Why is this important?
This review gave important insights into how adults with severe asthma define whether or not they have responded to biological therapy. People with severe asthma recognise grades or levels of response within a scale from positive to negative. Some patients may consider a small drop in asthma exacerbations or a lower dose of oral corticosteroids as a positive response. They feel this way even if it is not the huge improvement they had hoped for. This study also found that research trials often showed a limited improvement in patients’ quality of life following biological therapy. But patients often described a far greater improvement. This may suggest that the current methods to measure severe asthma patients’ quality of life are not well designed.
These findings will help to inform ongoing activities to develop a shared definition of whether or not a person responds to biological therapy for severe asthma. This will make sure that future research takes the patient perspective into account.
Read the full paper:
Support statement
Funding was received to support this work by the European Lung Foundation as part of the 3TR project. The 3TR project is funded by the Innovative Medicines Initiative (IMI) 2 Joint Undertaking (JU) under grant agreement number 831434. The JU receives support from the European Union’s Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA). Disclaimer: Content of this publication reflects only the authors’ view and the JU is not responsible for any use that may be made of the information it contains. The funder had no role in the design, conduct or write up of the narrative review or decision to publish. Further details about the 3TR project and IMI funding programme are available on their websites: www.3tr-imi.eu and www.imi.europa.eu.
