How to adjust asthma management once asthma is controlled on long term biologic therapy.

Abstract

Monoclonal antibodies that target IgE, IL5 or the IL5 receptor, the IL4 receptor alpha, or TSLP, have improved outcomes, reducing exacerbations, minimizing symptoms, improving lung function, and facilitating corticosteroid withdrawal. While it is even possible to achieve remission with these biologics, many patients inquire about the feasibility of discontinuing their biologic, their inhalers, or consideration of alternative dosing strategies. In this commentary, we review available data regarding the safety and efficacy of different asthma medication management options once asthma is controlled on long-term biologic therapy. We evaluate stopping of biologics while continuing inhaler therapy, stopping background therapy while continuing biologics, reducing biologic dose, increasing biologic interval, and other strategies including seasonal administration of biologics. It is clear that many patients can safely adopt some of these approaches that will make their lives easier, and potentially less expensive for patient and payers. What is needed is more research to tell us who, when, and how to adopt these alternative regimens.