Anti-IL-5 antibodies represent an established therapy for severe eosinophilic asthma (SEA), but some patients show inadequate response. This study’s objective was to assess the effects of a switch to anti-IL-5Rα therapy in patients with inadequate response to anti-IL-5 therapy. In this retrospective multi-center, real-life study, we analyzed all SEA patients who switched from anti-IL-5 to anti-IL-5Rα therapy due to inadequate response or intolerability. Pulmonary function tests, blood gas analyses, asthma control tests (ACT), and oral corticosteroid (OCS) usage were analyzed and compared at three-time points: baseline (BL, before anti-IL-5 therapy), timepoint 1 (T1, under anti-IL-5 therapy), and time point 2 (T2, under anti-IL-5Rα therapy).

Of 665 patients treated with anti-IL-5 antibodies, 70 were switched to anti-IL-5Rα, and 60 were included in the analysis. Median treatment duration was eight months [IQR 5; 15] for anti-IL-5 and five months [IQR 4; 6] for anti-IL-5Rα therapy. FEV1 was 61% of predicted at BL [IQR 41; 74], 61% [IQR 43; 79] at T1 and 68% [IQR 49; 87] at T2 (pT1-T2=0.011). ACT score was 10 [IQR 8; 13], 16 [IQR 10; 19] and 19 [IQR 14; 22], respectively (both p< 0.001). The number of patients requiring OCS was reduced from 41 (BL) to 32 (T1) and 19 (T2) (both p< 0.001). Ten patients discontinued anti-IL-5Rα therapy due to insufficient efficacy (n=7) and adverse events (n=3).

Switching from anti-IL-5 to anti-IL-5Rα therapy in patients with inadequate response was associated with significantly improved FEV1, asthma control, and OCS reduction.