Background

For therapy of severe asthma in adult patients, five monoclonal antibodies (biologics) are approved in Germany up to November 2022, but a clear algorithm on the choice of the initial therapy, assessment of response, and indications for switch to another biologic does not exist.

Aim

To assess current practice on the prescription and use of biologic therapy for severe asthma in Germany.

Methods

A questionnaire to assess indications and switch of biologics in severe asthma was created and send to 119 pulmonologists, all members of the German Asthma Net (GAN). The survey was conducted online, using SoSci Survey. Statistics were performed using SPSS.

Results

Forty-seven out of 119 pulmonologists took part in the survey. Exacerbations and oral steroid use were the most important factors for the decision to start a biologic therapy, these items were also used to monitor response. Most pulmonologists considered type-2 inflammation biomarkers and comorbidities (especially CRSwNP and atopic dermatitis), for choosing the initial biologic therapy. Asthma Control Test (ACT) was the most common instrument for assessing symptoms. There was no consensus on thresholds for response of pulmonary function tests including FEV1, FVC and RV. 85% of participants distinguished between "responders", "partial responders" and "non-responders". Comorbidities played an important role for the decision to switch to another biologic, e.g. when initial therapy had insufficient effectiveness on CRSwNP.

Conclusion

This study provides a detailed insight into current opinions and practice of antibody use in the treatment of severe asthma in Germany.