Choosing and switching biologics for patients with severe asthma – real-life data from the German Asthma Net (GAN)

With six biologics available to treat severe asthma, choosing and switching therapy is challenging. To describe patients’ characteristics depending on the chosen biologic and patterns of switch, we included adults from the GAN registry who were biologic-naïve at baseline. Between 2011 and 2023, 2297 patients with severe asthma newly received a biologic (28% anti-IL5R, 27% anti-IL5, 14% anti-IL4R, 27% anti-IgE, 5% anti-TSLP). Distribution of biologics varied between time periods reflecting their availability (Fig.1). Baseline characteristics differed between treatment groups: patients treated with anti-IgE were youngest at asthma diagnosis (mean 26years) and had highest rates of allergic comorbidities (80%). Blood eosinophils were highest in patients receiving anti-IL5R (median 435/µl), lowest in those receiving anti-TSLP (151/µl). FeNO was higher in patients treated with anti-IL5, anti-IL5R or anti-IL4R (median 39, 38 and 35ppb) than in those treated with anti-IgE and anti-TSLP (27 and 24ppb). 311 patients switched from the first biologic to a different one, the most frequent constellations being anti-IL5 to anti-IL5R (n=64), anti-IL5R to anti-IL4R (n=55) and anti-IL5 to anti-IL4R (n=42). Phenotyping patients with severe asthma determines the initial choice of biologic therapy in real-world practice. Choice and switch of biologic have evolved over time influenced by availability of different drugs. <fig><object-id>erj;66/suppl_69/PA1371/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>