COVID-19, asthma, and biological therapies: What we need to know

Abstract

Managing patients with severe asthma during the coronavirus pandemic and COVID-19 is a challenge. Authorities and physicians are still learning how COVID-19 affects people with underlying diseases, and severe asthma is not an exception. Unless relevant data emerge that change our understanding of the relative safety of medications indicated in patients with asthma during this pandemic, clinicians must follow the recommendations of current evidence-based guidelines for preventing loss of control and exacerbations. Also, with the absence of data that would indicate any potential harm, current advice is to continue the administration of biological therapies during the COVID-19 pandemic in patients with asthma for whom such therapies are clearly indicated and have been effective. For patients with severe asthma infected by SARS-CoV-2, the decision to maintain or postpone biological therapy until the patient recovers should be a case-by-case based decision supported by a multidisciplinary team. A registry of cases of COVID-19 in patients with severe asthma, including those treated with biologics, will help to address a clinical challenge in which we have more questions than answers.

Keywords: AAAAI, American Academy of Allergy, Asthma and Immunology; ACAAI, American College of Allergy, Asthma and Immunology; ACE2, Angiotensin-converting enzyme 2; ADCC, Antibody-Dependent Cell-mediated Cytotoxicity; AEs, Adverse events; Asthma; BTS, British Thoracic Society; Biologics; COVID-19; COVID-19, Coronavirus Disease 2019; DNA, Deoxyribonucleic acid; EBM, Evidence Based Medicine; ELF, European Lung Foundation; ERS, European Respiratory Society; FDA, Food and Drug Administration; GINA, Global Initiative for Asthma; GSK, Glaxo Smith Kline; ICS, inhaled corticosteroids; ICU, Intensive Care Unit; IL13, Interleukin 13; IL4, Interleukin 4; IL5, Interleukin 5; IL5Ra, Interleukin 5 alfa receptor; IL5r, Interleukin 5 receptor; IL6, Interleukin 6; IgE, Immunoglobulin E; NHLBI, National Heart, Lung, and Blood Institute; OCS, Oral corticosteroids; PDGFRA, Platelet-Derived Growth Factor Receptor A; PROSE study, Preventative Omalizumab or Step-up therapy for fall Exacerbations study; Pandemic; RCTs, Randomized Controlled Trials; SAEs, Serious Adverse Events; SARP, Severe Asthma Research Programme; SARS-CoV-2; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; SC, Subcutaneous; SIAAIC, Italian Society of Allergy, Asthma and Clinical Immunology; Severe; T2, Type 2 inflammation; TMPRSS2, Transmembrane Protease Serine 2 Enzyme; Treatment; USA, United States of America; mAb, Monoclonal antibody.