Purvi Parikh, MD: Pediatric Asthma Care with Biologics
November 23, 2019
The introduction of omalizumab (Xolair) to the pediatric asthma market brought a powerful biologic option to young patients not responding well enough to routine corticosteroid management. Since then, a series of other biologics have entered the space, giving physicians even more options.
In an interview with MD Magazine®, Purvi Parikh, MD, a pediatric allergist and clinical assistant professor in the Departments of Pediatrics and Medicine at NYU Langone Health, detailed the current state of care provided by biologics in pediatric asthma.
MD Mag: How do biologics particularly benefit pediatric and adolescent asthma patients?
Parikh: So, biologics have been almost a game-changer, especially for those who suffer from severe asthma, because a lot of these patients unfortunately are reliant on oral or injectable steroids throughout the years. And especially for pediatric patients, steroids come with a lot of side effects.
So, the nice thing about these biologics is that helps us minimize the use of steroids, and control their asthma better, along with other comorbid allergic illnesses. So, not only are we getting the asthma under control, but for many of these patients, we’re also getting their eczema under control, or their hives, or other things. It's kind of nice we can address multiple issues.
And it's also nice that we can control their asthma better and reduce their need for steroids.
MD Mag: Is there a standout biologic for pediatric asthma?
Parikh: So, it's very patient-dependent—just likeeverything else. Before, wereally only had omalizumab, or Xolair,but now we have other options which isnice, because one personmay react beautifully with the Xolair andare very well under control, whereas inanother patient, it may not work as wellfor.
Also, the comorbidconditions play a role. So there'scertain medicines like dupilumab whichhelp if they have asthma and eczema, whereas omalizumab works forasthma and hives—and possibly we'reseeing less reactivity in those food-allergic patients, too.
So, it's very nicethat now we can kind of tailor it child-to-child, whereas before we didn't have
MD Mag: Are there set strategies in place to aid physicians in switching biologics?
Parikh: Yes, absolutely. Just like anyother medication, if it's not workingwell and they're still havingasthma attacks or flare-ups, thenabsolutely we do switch.
We usually giveeach biologic 3-6 months totake effect, because it's not meant towork acutely. It's meant to bean add-on controller medicine inaddition to all the inhalers andother medicines they are taking.
So, we dohave to give it some time, but we doswitch if it's not working. Andespecially, some of the patients who hadbeen on omalizumab—the onesdoing great, we don't switch. But ifthey hadn't been doing great, now thatnew options are available, we do considerbecause maybe one may work better forthem.
The expectations, at least from thephysician standpoint, is that we shouldbe doing a better job controlling it nowthat we have so many more options. Unfortunately, 10 people still die everyday in this country from asthma, when that shouldn't happen at all becausewith all of the advances we have inmedications we have.
So, at least from thephysical position standpoint, theexpectations are high for controllingasthma. I'm hoping now, aspatients have more access to internetand TV and all of these things, thattheir expectations are also high forcontrolling it.
So, there's a bigeducation component that if their asthma is notcontrolled, they should be proactiveabout asking the physician why and ifthere's other options, too.
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