Long-Term Weight Changes After Starting Anti-IL-5/5Ra Biologics in Severe Asthma: The Role of Oral Corticosteroids

Lianne Ten Have; Edith Visser; Fleur L Meulmeester; Sarah A Bendien; Gert-Jan Braunstahl; Marielle E A C Broeders; Karin B Fieten; Simone Hashimoto; Astrid van Huisstede; Bas Langeveld; Karen T M Oud; Kornelis W Patberg; Frank W J M Smeenk; Anneke van Veen; Ilonka H van Veen; Marjo J T van de Ven; Els J M Weersink; Kim de Jong; Jacob K Sont; Johannes A Kroes; Anneke Ten Brinke

doi:10.1016/j.jaip.2023.06.054

Long-Term Weight Changes After Starting Anti-IL-5/5Ra Biologics in Severe Asthma: The Role of Oral Corticosteroids

J Allergy Clin Immunol Pract. 2023 Sep;11(9):2748-2756.e3. doi: 10.1016/j.jaip.2023.06.054. Epub 2023 Jul 1.

Authors

Lianne Ten Have¹, Edith Visser², Fleur L Meulmeester³, Sarah A Bendien⁴, Gert-Jan Braunstahl⁵, Marielle E A C Broeders⁶, Karin B Fieten⁷, Simone Hashimoto⁸, Astrid van Huisstede⁹, Bas Langeveld¹⁰, Karen T M Oud¹¹, Kornelis W Patberg¹², Frank W J M Smeenk¹³, Anneke van Veen¹⁴, Ilonka H van Veen¹⁵, Marjo J T van de Ven¹⁶, Els J M Weersink⁸, Kim de Jong², Jacob K Sont³, Johannes A Kroes¹⁷, Anneke Ten Brinke¹⁸

Affiliations

¹ Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands; Department of Biomedical Data Science, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: lianne.ten.have@mcl.nl.
² Department of Epidemiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
³ Department of Biomedical Data Science, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Department of Respiratory Medicine, HAGA Teaching Hospital, Den Haag, The Netherlands.
⁵ Department of Respiratory Medicine, St Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands.
⁶ Department of Respiratory Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
⁷ Nederlands Astmacentrum Davos, Davos, Switzerland; Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland.
⁸ Department of Pulmonary Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
⁹ Department of Pulmonary Medicine, Northwest Clinics, Alkmaar, The Netherlands.
¹⁰ Department of Respiratory Medicine, Deventer Ziekenhuis, Deventer, The Netherlands.
¹¹ Department of Respiratory Medicine, Ziekenhuis Gelderse Vallei, Ede, The Netherlands.
¹² Department of Respiratory Medicine, ISALA Clinics, Zwolle, The Netherlands.
¹³ Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands.
¹⁴ Department of Respiratory Medicine, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
¹⁵ Department of Respiratory Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
¹⁶ Department of Respiratory Medicine, Rijnstate Hospital, Arnhem, The Netherlands.
¹⁷ Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
¹⁸ Department of Pulmonary Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands.

PMID: 37399945
DOI: 10.1016/j.jaip.2023.06.054

Abstract

Background: Many patients with severe asthma are overweight or obese, often attributed to unintentional weight gain as a side effect of oral corticosteroids (OCSs). Anti-IL-5/5Ra biologics significantly reduce OCS use, but their long-term effects on weight are unknown.

Objectives: To examine (1) weight change up to 2 years after anti-IL-5/5Ra initiation in subgroups on the basis of maintenance OCS use at start of treatment and (2) whether cumulative OCS exposure before or changes in OCS exposure during treatment are related to weight change.

Methods: Real-world data on weight and cumulative OCS dose from adults included in the Dutch Registry of Adult Patients with Severe asthma for Optimal DIsease management before and at least 2 years after starting anti-IL-5/5Ra were analyzed using linear mixed models and linear regression analyses.

Results: For the included 389 patients (55% female; mean body mass index, 28 ± 5 kg/m²; 58% maintenance OCS), mean weight decreased -0.27 kg/y (95% CI, -0.51 to -0.03; P = .03), with more weight loss in patients with maintenance OCS use than in those without maintenance OCS use (-0.87 kg/y [95% CI, -1.21 to -0.52; P < .001] vs +0.54 kg/y [0.26 to 0.82; P < .001]). Greater weight loss at 2 years was associated with higher cumulative OCS dose in the 2 years before anti-IL-5/5Ra initiation (β = -0.24 kg/g; 95% CI, -0.38 to -0.10; P < .001) and, independently, greater reduction in cumulative OCS dose during follow-up (β = 0.27 kg/g; 95% CI, 0.11 to 0.43; P < .001).

Conclusions: Anti-IL-5/5Ra therapy is associated with long-term weight reduction, especially in patients with higher OCS exposure before treatment and those able to reduce OCS use during treatment. However, the effect is small and does not apply to all patients, and so additional interventions seem necessary if weight change is desired.

Keywords: Airway inflammation; Biologics; Body mass index; Corticosteroids; Eosinophilic asthma; Extrapulmonary traits; Multicenter; Severe asthma.

MeSH terms

Administration, Oral
Adrenal Cortex Hormones
Adult
Anti-Asthmatic Agents*
Asthma* / chemically induced
Asthma* / drug therapy
Biological Products* / adverse effects
Female
Humans
Male

Substances

Anti-Asthmatic Agents
Biological Products
Adrenal Cortex Hormones