Introduction

Biologics have been shown to reduce exacerbation-rate and improve quality of life in children with severe asthma. However, real-life studies in children are scarce and there is still a substantial non-response rate.

Aim

Compare clinical characteristics at baseline and response rates after 6 months between children identified by paediatric pulmonologists to start a biologic (starters) and who were not (non-starters).

Methods

We performed an analysis in the Paediatric-Asthma-Non-Invasive-Diagnostic-Approaches (PANDA) study on children with severe asthma 6-17 years; treated according to Global Initiative for Asthma step ? 4).  Differences in clinical characteristics were explored at baseline and a composite score consisting of number of oral corticosteroids (OCS) courses, lung function (FEV1post-BD%pred), Asthma-Control-Test (ACT) and Paediatric-Asthma-Quality-of-Life-Questionnaire (PAQLQ), was used to measure response rates after 6 months. 

Results

31 children (mean age 11.1±2.9 years, 68% male) were included, of whom 10 starters. Starters were less often Caucasian (p.0.02), had a better therapy adherence (p.0.007) measured by Medication-Adherence-Report-Scale (MARS-5), a lower FEV1post-BD%pred (p.0.02) and higher OCS-use (p.0.03). 17 children completed the six-month follow-up, of which 6 starters. The response rate in starters was 50%, whereas 82% of the non-starters showed respons. 

Conclusion

Exacerbation-rate, therapy adherence, ethnicity and lung function seem to be determinative factors in the decision making process of starting a biological. Furthermore, response rate is still suboptimal, underlining the importance of identifying new (bio)markers for prediction of response.