C25-20 Real-World Effectiveness of Asthma Biologics by Age of Initiation and Early-Childhood Risk Factors

Abstract Background Several biologics are approved in the U.S. for the treatment of severe asthma in children aged ≥6 years, but important knowledge gaps persist regarding their real-world effectiveness. Methods Retrospective, EHR-based cohort of children with moderate/severe asthma treated with a biologic by pediatric subspecialists between 12/2019 and 12/2024. We used piecewise generalized linear mixed-effects models to examine clinical benefit of asthma biologics, defined as the change in the odds of severe asthma exacerbations before vs. after treatment initiation. Results The cohort was comprised of 122 children (51.2% female, 60.5% Black, mean age 10±4 years at biologic initiation) who were prescribed dupilumab (63%), omalizumab (27%), or mepolizumab (10%) and had follow-up data for a median of 10 years. Initiation of biologics for asthma led to significant reductions in severe exacerbations (adjusted OR = 0.48 95%CI=0.30-0.77) (Figure 1A). Clinical benefit was more pronounced with younger age at initiation: adjusted OR = 0.45 95%CI=0.26-0.81 in ≤ 11-years-olds, vs aOR=0.53 95%CI: 0.25-1.13 in those ≥12 years (Figure 1B and 1C). Similarly, reduction in severe exacerbations was more pronounced among patients who had a history of early-childhood atopic polysensitization (aOR=0.38 95%CI=0.18-0.80 than those without (aOR=0.57 95%CI=0.31-1.05) and in patients with a moderate to high burden of early-childhood asthma risk factors (aOR=0.42 95%CI=0.42-0.43) than those with low burden (aOR=0.71 95%CI=0.28-1.77). Black patients had higher exacerbation rates than White patients, but the effectiveness of biologics was similar for both groups. We found no significant differences by biologic agent. Conclusion Biologics may be more effective with earlier treatment initiation, especially among children with early polysensitization or multiple early-childhood risk factors. Screening for these risk factors may help inform targeted early initiation of biologics for asthma. This abstract is funded by: NIH