Elsevier

Respiratory Medicine

Volume 177, February 2021, 106287
Respiratory Medicine

Poor outcome of SARS-CoV-2 infection in patients with severe asthma on biologic therapy

https://doi.org/10.1016/j.rmed.2020.106287Get rights and content
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open access

Highlights

  • Severe asthma patients on biologics might be more susceptible for COVID-19.

  • SARS-CoV-2 is not an important trigger for asthma exacerbations in these patients.

  • Severe COVID-19 may be more frequent in asthma patients on biologic therapy.

  • Contributing factors may be the commonly observed co-morbidities such as obesity.

Abstract

Background

It is unclear whether asthma and asthma medications increase or decrease the risk of severe COVID-19, and this is particularly true for patients with severe asthma receiving biologics.

Objectives

The aim of this study was to assess incidence and disease course of COVID-19 in patients with severe asthma on biologic therapy (omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab), as compared with COVID-19 data from the general Dutch population.

Methods

COVID-19 cases were identified through a prospective ongoing survey between March 17 and April 30, 2020 among all severe asthma specialists from 15 hospitals of the Dutch Severe Asthma Registry RAPSODI. From these cases, data was collected on patient characteristics, including co-morbidities, COVID-19 disease progression and asthma exacerbations. Findings were then compared with COVID-19 data from the general Dutch population.

Results

Of 634 severe asthma patients who received biologic therapy in RAPSODI, 9 (1.4%) were diagnosed with COVID-19. Seven patients (1.1%) required hospitalization for oxygen therapy, of which 5 were admitted to the intensive care for intubation and mechanical ventilation. One patient died (0.16%). All intubated patients had ≥1 co-morbidities. Odds (95%CI) for COVID-19 related hospitalization and intubations were 14 (6.6–29.5) and 41 (16.9–98.5) times higher, respectively, compared to the Dutch population. One patient presented with an asthma exacerbation.

Conclusion

Patients with severe asthma using biologic therapy showed to have a more severe course of COVID-19 compared to the general population. This may be due to co-morbidities, the severity of asthmatic airway inflammation, the use of biologics, or a combination of these.

Keywords

Biologics
COVID-19
SARS-CoV-2
Severe asthma

Abbreviations

COVID-19
corona virus disease 2019
IL
interleukin
OCS
oral corticosteroids
receptor alpha
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2

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