Background and importance Immunotherapy is used in those patients with severe uncontrolled asthma (SUA) despite treatment with inhaled glucocorticoids (IGC) and beta2 adrenergic agonists (LABA) at high doses, and/or oral glucocorticoids (OGC), but it seems that its effectiveness is lost over time.

Aim and objectives The aim of this study was to measure the effectiveness and safety of immunotherapy in SUA in clinical practice.

Material and methods A multicentre and retrospective study was performed in SUA patients from two Spanish centres who received treatment with immunotherapy (omalizumab, mepolizumab or benralizumab) since March 2017 to October 2021. We registered: sex, age, patients that maintained response after 2 years of treatment, loss of response, median follow-up (mFU). Effectiveness was evaluated as a reduction in OGC, exacerbations and/or urgency visits. Safety in terms of side effects (SE) and patient-reported outcomes with Asthma Control Test (ACT) score (<19 points = poor control) was also assessed. A dispensation program and the Diraya clinical station were used as sources of information.

Results 56 patients were included, 46 females, with a median age of 60 (7–86) years. The mFU was 60. 21 and 15 months with omalizumab, mepolizumab and benralizumab, respectively. The treatment was effective in 82% of all patients. 21%, 15% and 15% of patients were non-responders with omalizumab, mepolizumab and benralizumab, respectively.

65%, 50% and 23% of patients maintained the response after 2 years with omalizumab, mepolizumab and benralizumab, respectively. 30%, 15% and 7.6% of the patients experienced loss of response with omalizumab, mepolizumab and benralizumab, respectively, after a median of 60, 18 and 14 months.

ACT score was collected in 17 patients in our pharmacist consultation. Patients with ACT score <19 (n=5) were recommended to advance their medical appointment to evaluate whether to continue with treatment. Regarding safety, 9 patients suffered SE, the most frequent being recurrent respiratory infections.

Conclusion and relevance Immunotherapy was effective in most cases with an acceptable safety profile. Due to loss of response over time, we must take advantage of the monthly or bimonthly visits of these patients to the pharmaceutical consultation to carry out a more exhaustive follow-up and thus collaborate with pulmonologists and allergists in the management of these patients.

Conflict of interest No conflict of interest