Biomarkers in Shifting the Treatment Paradigm of Asthma - Episode 13

Safety Concerns With Biologics During the COVID-19 Pandemic

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Transcript: Thomas Casale, MD: Let me throw this out to the group. Do you have any concerns during this COVID-19 [coronavirus disease 2019 pandemic] of starting a particular biologic or continuing 1 of those 5 biologics?

Stanley Goldstein, MD: We’ve had patients calling and saying they want to come to the office to get their biologic. I just had a patient who called yesterday. It just so happens he has been diagnosed with COVID-19, and he’s due for his biologic. I’m not bringing him to the office, but I have no concern about using it during the time of their exposure or even if they have it. It has not been shown to increase any lung issues, even in patients who have asthma exacerbation. Even on the same day, also no increase. I’m not concerned about using it or giving it to these patients as far as making them more susceptible to COVID-19.

Michael Wechsler, MD, MMSc: I would be cautious, however, if you’re going to start someone on a biologic in this era, about interpreting responsiveness because it could be confounded by concurrent COVID-19 infection. You may say the person is not responding, but it may be that their response is because of some other factor. I would just be cautious about it. I agree with Stan. I don’t have any specific concerns about either continuing or starting these therapies for any of our patients.

Syed Shahzad Mustafa, MD: I would just go one step further. I agree with the group about not having any concerns about continuing or initiating therapy with biologics. I would say what Mike said earlier. I think we need to be even more diligent than usual to control the asthma for our patients. It may be even more important to be a little more proactive about people with poorly controlled asthma and to now more than ever get them under control.

Geoffrey L. Chupp, MD: My approach at our center has been the same. It’s critical to maintain disease control in this patient population, and biologics are a key part of that in many of these individuals. And there’s really no evidence that their risk of acquiring COVID-19 or having a severe case of it would increase. I think the major issue is mitigating risk of COVID-19 by getting your in-office injections. We’ve really done 2 things at our center, one is we’ve tried to transition these patients to home dosing, auto-injection, as much as possible, when possible. If they do come into our center for their injections, we’ve reduced the visits down to one visit per hour so we can make sure that there’s not a waiting room full of patients sitting next to each other.

Thomas Casale, MD: Geoff, in that regard, if you’re going to start a patient on a biologic now, would you pick 1 that is approved for home administration?

Geoffrey Chupp, MD: I think I would lean to that. I did that yesterday through a telehealth visit. We have that set up at our center with pharmacists who do teaching with the patient remotely through a video visit, the drug is delivered to the home, and the patient can start it. I think that’s a great way to protect your patients from COVID-19 and enhance their asthma control.

Transcript Edited for Clarity