{"doi":"10.1016/j.anai.2024.01.010","title":"Corticosteroid-sparing effect of biologics in patients with allergic bronchopulmonary aspergillosis","abstract":"Allergic Bronchopulmonary Aspergillosis (ABPA) is a disease characterized by asthmatic symptoms and recurrent exacerbations due to Aspergillus antigen hypersensitivity in patients with asthma or cystic fibrosis. Current guideline-directed treatment centers around oral corticosteroids (OCS), which have numerous side effects especially with chronic use.1 Biologic agents specifically targeting eosinophils, IgE, and related Type 2 cytokines have proven efficacy in related disorders such as severe asthma. Patients with ABPA on chronic OCSs represent a subgroup with high disease burden who are particularly situated to benefit from novel therapeutics. We designed a retrospective analysis examining biologic use in this population and association with change in OCS dose. A retrospective chart review was performed to identify patients with ABPA at a tertiary medical center treated with one or multiple biologics (i.e. benralizumab, dupilumab, mepolizumab, omalizumab, reslizumab, and tezepelumab) between 1/1/2012 and 7/11/2022. Individuals were classified as corticosteroid-dependent if they were prescribed a daily oral corticosteroid for at least 4 weeks prior to biologic initiation. The primary outcome was change in corticosteroid dose in prednisone equivalents. The OCS dose at biologic initiation and either discontinuation of biologic or end of study period was compared using a two-tailed paired t-test. Patients were excluded if they did not meet diagnostic criteria for ABPA, they never initiated biologic therapy, they were not corticosteroid-dependent, or OCS doses could not be determined. If a patient had been prescribed multiple biologics, each biologic trial was analyzed independently in terms of the primary outcome, treatment duration, and adverse effects, but each patient was counted once in the reporting of demographic information, medication use, comorbidities, and diagnostic testing. The electronic medical record query yielded 69 patients of which 20 patients with ABPA were identified that met inclusion criteria. There were 29 biologic trials (six benralizumab, three dupilumab, five mepolizumab, fifteen omalizumab) identified. Patient demographic information, comorbidities, medications, and diagnostic testing are summarized in Table 1. The median age of biologic initiation was 56 years. All patients had a chart diagnosis of asthma, and two patients had cystic fibrosis. All patients were on an inhaled corticosteroid at time of biologic initiation, and most patients had taken or were taking an antifungal agent and/or leukotriene receptor antagonist. Thirty-five percent of patients had tried two or more biologics. The order of biologics trialed was variable and influenced by various factors including availability (not all biologics were approved throughout the entire study period or covered by the patient's insurance) and provider and patient preference. The median peak IgE was 4,056 IU/mL and median absolute eosinophil count of 1,200/mm3. 85 percent had bronchiectasis noted on computed tomography.Table 1Patient Characteristics. Values are presented as median (interquartile range), mean ± standard deviation, or n (percentage). N is the number of patients with available data. *Positivity based on I-SHAM criteria.9 **Third quartile could not be determined definitively due to assay cutoffs. FEV1 forced expiratory volume, FVC forced vital capacity.Patient CharacteristicValueNDemographics Male8 (40%)20 Age (years)56 (43.75-66.25)20 Non-Hispanic White13 (65%)20 Hispanic or Latino6 (30%)20 Black or African American1 (5%)20Associated Conditions Cystic Fibrosis2 (10%)20 Asthma20 (100%)20Comorbidities Allergic Rhinitis18 (90%)20 Ever Smoked11 (55%)20# of Biologics Trialed One13 (65%)20 Two3 (15%)20 Three4 (20%)20Other Medications Inhaled Corticosteroid20 (100%)20 Antifungal Agent18 (90%)20 Leukotriene Receptor Antagonists19 (95%)20Markers of Aspergillus Sensitization* IgE Aspergillus (kU/L)39.1 (12.6-61.7)20 IgE Aspergillus Positive19 (95%)","journal":"Annals of Allergy Asthma & Immunology","year":2024,"id":464599,"datarank":0.24141568686511508,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"self_citation_contribution":0.24141568686511508,"citation_network_contribution":0.0,"self_endowment_contribution":0.24141568686511508,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9553,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":354130,"name":"Praveen Akuthota","orcid":"0000-0001-6655-7520","position":1,"is_corresponding":false},{"id":1295885,"name":"K.A. Darragh","orcid":null,"position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:04:42.082401Z","pmid":"38232815","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}