Patient-reported Therapeutic Experiences with Biologic Agents in Aspirin-Exacerbated Respiratory Disease

Respiratory biologics are FDA approved for the treatment of severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). However, there is limited data regarding patterns of utilization and efficacy of respiratory biologics in aspirin-exacerbated respiratory disease (AERD), a chronic disease characterized by asthma, CRSwNP, and hypersensitivity reactions to cyclooxygenase-1 inhibitors. We sought to characterize the patient experience with respiratory biologics for the treatment of AERD. We surveyed 98 adult patients with AERD recruited from the Brigham and Women’s Hospital AERD registry. Patients completed an online questionnaire describing their medication history and treatment experience. Fifty-two (53.0%) patients reported a history of biologic use (omalizumab, mepolizumab, reslizumab, benralizumab, and/or dupilumab), including 48 (49.0%) patients currently on a respiratory biologic for AERD treatment. Twenty patients had trialed multiple biologic agents. The most common reason cited for biologic discontinuation was lack of efficacy; side effects were rarely reported as a reason for discontinuation. Among 30 instances of biologic discontinuation, all but 4 patients were transitioned to a different biologic. The majority of patients who transitioned biologic therapy ultimately started dupilumab; no patients switched from dupilumab to another biologic. Compared to other biologics, dupilumab had the highest odds of participants reporting it worked “Very Well,” (OR 17.58 [95% CI: 5.68-54.35, p <0.0001]), with response options “Very Well”, “OK”, “Not at all” and “Not Sure.” Biologics have an emerging role in the management of AERD, and are generally well-tolerated. Biologic efficacy in AERD is variable by agent, though the majority of patients found dupilumab effective.