P100 Real word effectiveness of anti IL-5/IL-5R therapies in severe asthma with fungal sensitisation

Introduction Severe asthma with fungal sensitisation (SAFS) is a complex clinical phenotype associated with poorly-controlled T2 inflammation and significant morbidity from both the disease itself and a high steroid burden. There are limited data on the effectiveness of biologic therapies targeting the IL-5/eosinophil pathway in this patient group. Methods We assessed the real-world effectiveness of treatment with mepolizumab or benralizumab in patients with SAFS and compared the outcomes with severe atopic asthmatics without fungal sensitisation (SAA) and severe non-atopic asthmatics (SNA). Baseline clinical characteristics and clinical outcomes at 48-weeks were evaluated. A sub-group analysis was performed of SAFS patients who met criteria for serological ABPA. Results 193 patients treated with mepolizumab (n=63) or benralizumab (n=130) were analysed. 42 patients were defined as SAFS, 99 as SAA and 52 as SNA. Patients with SAFS had a higher baseline IgE compared to patients with SAA and SNA (mean ± standard deviation: 1135±1563 IU/ml vs 343±530 and 142±171, respectively; both p Discussion Patients with SAFS demonstrated similar improvements in clinical outcomes to severe eosinophilic patients without fungal sensitisation. A subgroup of patients with ABPA demonstrated reduction in exacerbation frequency. These data highlight the clinical effectiveness of targeting eosinophilic inflammation in SAFS and ABPA.