Severe asthma patients on biologics predisposed to severe COVID-19

Patients with severe asthma receiving treatment with biologics are more likely to contract COVID-19 and develop a severe course as compared with the general population, a study has found.

The study used data from the Dutch Severe Asthma Registry RAPSODI and included 634 severe asthma patients who received biologic therapy (19 percent omalizumab, 39 percent mepolizumab, 16 percent reslizumab, 19 percent benralizumab, and 7 percent dupilumab).

Nine patients (1.4 percent) were diagnosed with COVID-19, of which one presented with an asthma exacerbation. Seven patients (1.1 percent) required hospitalization for oxygen therapy by nasal canula or nonrebreather mask, and five of them were admitted to the intensive care unit for intubation and mechanical ventilation. One patient died (0.16 percent).

All intubated patients had one or more comorbidities, which included obesity, diabetes, and cardiovascular disease. None of the patients received continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), or extracorporeal life support (ECLS).

Relative to the general Dutch population, severe asthma patients receiving biologics had greater odds of contracting COVID-19 (odds ratio [OR], 4.6, 95 percent confidence interval [CI], 2.3–9.2; p<0.0001), being hospitalized (OR, 14.0, 95 percent CI, 6.6–29.5; p<0.0001), being intubated (OR, 40.8, 95 percent CI, 16.9–98.5; p<0.0001), and dying (OR, 5.0, 95 percent CI, 0.7–35.8; p=0.106).

Why the study population progressed to more severe COVID-19 is uncertain, but this phenomenon can be attributed to comorbidities, the severity of asthmatic airway inflammation, the use of biologics, or a combination of these.