Understanding Biologic Therapy Discontinuation
I was an early adopter to biologic therapy for my asthma. In the beginning, it offered hope in what was becoming a trail of failed therapies, worsening symptoms, and loss of asthma control. I clearly remember discussions with my Specialist that mentioned “limited long term data" and that it was really important not to make things worse. We were entering "unknown territory."
Trying biologic therapy
We cautiously entered into biologic treatment. In my case, it wasn’t until after extensive testing, diagnosis reconfirmation, and failed therapies that we embarked on this journey. I was often frustrated by how slow we were moving at the beginning. I wanted symptom relief, and I wanted it NOW.
Initially, there was not much discussion of how long I would be on a biologics. There was just hope that they would work - make things a bit better. Now that there are longer-term data available, the questions about when to discontinue biologics for asthma have been raised. There was a recent case report published that looked at a patient that had been in the clinical studies for a biologic, then on prescribed treatment who was discontinued after their symptoms were stabilized.1 The main caveat seems to be getting to a point of full symptom control, no exacerbations, no OCS therapy, and normal lung function.
Biologic therapy duration
I recently learned that determining therapy duration with biologics is one of the main challenges for clinicians, as the criteria are not yet clearly defined. In general, asthma therapies are usually adjusted in response to symptom control. Meanwhile, the definition of symptom control on biologics has not yet been fully established.
In the case study, the patient who discontinued biologic use returned to its use after a few months. The challenge is that some patients responded by retaining symptom control and others had symptoms return after discontinuing biologic use. Therefore, it will be important that biomarkers are established to guide drug withdrawal. It is especially important to understand the risk of exacerbations following biologic withdrawal.1
My experience with biologics for my asthma
This had me thinking about my own experiences with biologics for asthma and understanding what my goals were. My initial goals were to gain and maintain better symptom control and OCS (Oral Corticosteroid) reduction. There have been times when I have been completely free of OCS, which has been delightful. I would like to get to a point where I can completely be off of them.
Understanding guidelines for discontinuing biologics
I had to return to OCS use during a period in which I was not on a biologic. It is my understanding that there may not be data and guidelines on when to step down biologics treatment. Yet, another conundrum for clinicians. In my experiences, other treatments like OCS have been reduced or additional add on therapy discontinued. I have had short periods in which my symptoms were controlled. However, I have also had to return to biologic therapy. I am looking forward to there being further guidelines for discontinuation or monitoring of long term use. In the interim, I will enjoy my bout of mostly controlled asthma.
Have you been on a biologic long term? I would love to hear about your experiences or even your discontinuation study.
What has your experience with Singulair been like?