INTRODUCTION

Biological therapies are proven to improve outcomes for patients with severe asthma (SA) however we lack established guidelines for switching between different biologics.

AIMS

We present real-world experience of switching patterns at our centre where patients have high insurance premiums without significant prescribing restrictions.

METHODS

This is a retrospective study of 59 SA patients treated with biologics between June 2010 to December 2022. Biologics switches were defined as stopping one biologic and starting a different one within 6 months. Switching was at discretion of treating physicians depending on asthma control and exacerbations.

RESULTS

Switching took place in 20 % (12/59) patients with national insurance premiums without prescribing restrictions.  58 % (7/12) patients were females. 

50% (6/12) patients had their first switch to Benralizumab, 33% (4/12) to Dupilumab and 17% (2/12) to Mepolizumab. Highest switch was from Omalizumab to Benralizumab at 50% (6/12). The mean time for first switch was 472 days. Common reasons for first switch were suboptimal response in 67 % (8/12),  side-effects 25% (3/12) and non-compliance 8% (1/12). In 7 % (4/59) biologics were switched twice as below: 

1-      Omalizumab ? Benralizumab ? Dupilumab

2-      Omalizumab ? Mepolizumab - Dupilumab

3-      Omalizumab ? Dupilumab ? Benralizumab

4-      Mepoluzimab ? Dupilumab ? Benralizumab

CONCLUSION

Real-world switching of biologics occurred in 1 in 5 patients (20%) in this UAE population with high insurance premium and in 7% patients twice. Switching is becoming increasingly common with approval of additional biologics.