Real-World Effectiveness of Reslizumab in Patients With Severe Eosinophilic Asthma - First Initiators and Switchers.

BACKGROUND: Reslizumab, a biologic targeting IL-5, has been shown to reduce asthma exacerbations and maintenance oral corticosteroid use in randomized controlled trials and pre-post studies in patients with severe eosinophilic asthma. However, real-world effectiveness data of reslizumab are scarce, and it is unknown whether reslizumab has added value after switching from another type 2 biologic. OBJECTIVE: To evaluate (1) the real-world effectiveness of reslizumab on severe asthma exacerbations, maintenance oral corticosteroid use, and overall treatment response, both in biologic-naive patients who initiated reslizumab and in those who switched from another type 2 biologic; and (2) physicians' experience with reslizumab treatment. METHODS: This observational real-world study evaluated data from 134 adults with severe eosinophilic asthma included in the Dutch severe asthma registry (RAPSODI), who initiated reslizumab treatment (4-weekly infusions, 0.3 mg/kg) before April 2020 and had follow-up data for 6 months and greater. Clinical asthma experts completed surveys on their experience with reslizumab treatment. RESULTS: Overall, reslizumab reduced the exacerbation rate (odds ratio [95% CI] = 0.10 [0.05-0.21]; P < .001), oral corticosteroid use (OR [95% CI], 0.2 [0.0-0.5]; P < .001), and maintenance dose (median [CI], 5.0 [0.0-10.0] to 0.0 [0.0-5.0]; P < .001), with comparable results in biologic-naive reslizumab initiators and switchers. The overall response to reslizumab was graded good or excellent in 59.2% of patients. The additive effectiveness of reslizumab after switching from another biologic was reflected in physicians' surveys. CONCLUSIONS: Real-world data show that reslizumab reduces severe asthma exacerbations and oral corticosteroid use in patients with severe eosinophilic asthma, both in biologic-naive reslizumab initiators and in those who switched from another type 2 biologic. This additional value of reslizumab was recognized by clinical asthma experts.

Diaphragm dysfunction prior to intubation in a patient with Covid-19 pneumonia; assessment by point of care ultrasound and potential implications for patient monitoring.

The clinical research described in this case report was initiated because of the recognized need for early identification of Covid-19 patients at risk of respiratory failure. We used point of care ultrasound to identify diaphragm dysfunction in a spontaneously breathing Covid-19 patient. Measurements of diaphragm thickness and thickening fraction indicated diaphragm dysfunction prior to intubation while respiratory failure was not yet evident from arterial blood gas analysis. Recovery of diaphragm contractility was demonstrated within two days of controlled mechanical ventilation when the patient was switched to a pressure support mode. With recovery of the diaphragm very large fractional shortening was seen after discontinuation of rocuronium, which was associated with a reduced dynamic compliance. In conclusion, this case report illustrates the need to be aware of potential diaphragm dysfunction in spontaneously breathing Covid-19 patients. With recovery, point of care ultrasound allows repeated evaluation of diaphragm function which appears to be responsive to changes in pulmonary compliance.