New research has highlighted the feasibility of a more personalised approach to biologic therapy in patients with severe asthma, having identified a group of patient characteristics that seem to increase the risk of a sub-optimal response to treatment.

For the post-hoc analysis, published in Respiratory Research, the team pooled data from two Phase III trials (DREAM and MENSA) which assessed mepolizumab in severe eosinophilic asthma.

Both studies had similar inclusion criteria which sought to ensure involvement of patients most likely to benefit from biologic therapy, including a confirmed history of two or more exacerbations requiring oral corticosteroid treatment in the prior year.

For comparability, the analysis included only those patients in the trials who received placebo (n=320, mean age 47.7 years, 60% female) or intravenous 75mg doses of mepolizumab (n=314 patients, mean age 49.8 years, 60% female).

Statistical analysis found exacerbation history, blood eosinophil count, ACQ5 score and age to be key predictors of treatment benefit for severe exacerbations. For asthma symptom control, blood eosinophil count and presence of nasal polyps had the greatest impact on response to advanced therapy.

“A precision medicine approach based on multiple patient characteristics can guide biologic therapy in severe asthma, especially in identifying patients who will not benefit as much from therapy,” the researchers said.

However, “patient characteristics had a greater capacity to predict treatment response to asthma control than to exacerbation,” they added.

The authors noted that a key implication of their findings is the potential for increased cost-effectiveness of advanced therapies for healthcare systems, which has been a key barrier to their uptake.

Based on the results, “a 60% improvement in the efficiency of mepolizumab would be achieved in terms of asthma symptom control if it were given to the 40% of eligible patients with the highest likelihood of improvement in symptom control, or to the 20% of eligible patients with the highest predicted reduction in exacerbations”, they said.

The authors also pointed out that the findings suggest that “a more accurate selection for treatment based on a combination of patient characteristics is feasible” given that “the results were obtained despite the fact that patients were already pre-selected for the likelihood of response to biologics, as reflected in the inclusion criteria of the two RCTs”.

However, looking forward, any clinical prediction models developed on the back of these feasibility findings “should be performed in real-world data with adjustment for medication adherence and other real-world factors for biologic initiation, which should include a broader class of biologic drugs,” they stressed.

The data supporting the findings of the analysis are sponsored by GlaxoSmithKline.