Asthma

Biologics effective for paediatric severe asthma — but families unsure on home injections


Biologics are able to significantly improve asthma symptoms in children and adolescents, but families and patients have conflicting sentiments about whether they’d want to undertake these injections at home, a small study from the Sydney Children’s Hospital, has found.

Published in Acta Paediatrica, clinicians at the hospital reported on treatment experiences for 11 teenagers (aged 12–17) receiving monoclonal antibody therapy for asthma between 2017 and 2000. Nine of the patients received omalizumab, while the remainder received mepolizumab.

At baseline, all participants were using high-dose inhaled corticosteroids with a long-acting beta-agonist (ICS/LABA), with no change in dosage over the six-month study period. Six children were using oral steroids prior to biologic therapy of whom three stopped within six months.

During the six month study periods asthma control improved (mean ACQ-5 score reduced from 3.7 to 2.0)  and hospitalisations reduced, in line with a drop in mean FeNO from 83 to 43 parts per billion (ppb). There was no significant change in lung function (FEV1, 81 to 80; FVC, 96 to 101 or FEV1/FVC, 73 to 70).

Using surveys of both the patients and their carers, the team found that 80% thought asthma control was better following the therapy, and participants rated the injection pain as a 3/10. Treatment adherence was fair, with 7/11 patients having one prescribed dose not dispensed over six months.

The study investigators noted that biologics are suggested in the fifth step of the Global Initiative for Asthma management guidelines for children and adolescents with severe asthma. The prefilled syringes for subcutaneous injection are currently administered in medical settings where there is access to emergency care, although there is potential to reduce treatment burden and costs for families with home injections.

However while most parents and carers indicated a desire to try home injections of biologics, patients did not share this view.

In the study, eight carers (80%) indicated they would be ‘slightly’ or ‘much happier’ with at-home injections, whilst seven (70%) participants were ‘neutral’ or would be ‘slightly less happy’. Six participants (60%) would prefer their carer to administer home injections, and seven carers (70%) preferred for themselves to administer the injection.

Lead author Dr Megan Sheppard, a Sleep Fellow specialising in Respiratory care at Westmead, said the findings supported the use of asthma biologics to treat severe paediatric asthma.

“We highlight the treatment burden hospital-based injections impart on patients and carers and raise awareness about the need for more consideration to be given to home-injections,” she told the limbic.

“These results were expected, however adherence would need to be closely monitored if home injections were to be introduced,” she said.

“There is the prospect of the children being able to access these medications at home, however appropriate models of care need to be introduced and suitability should be assessed by a specialist on a case-by-case basis,” she added.

In 2020, the PBS expanded the eligibility of patients for the three biologic therapies for asthma currently available and a six month wait time between trials was dropped.

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