Guidance for Administering Biologics for Severe Asthma and Allergic Conditions.

Asthma is a common respiratory disorder in Canada for which biologics may be prescribed for poorly controlled illness. Treatment with biologics, however, is sometimes inappropriately discontinued due to misconceptions regarding their potential immunologic effects, and concerns surrounding their continued use in severe asthma during the COVID-19 pandemic continue to propagate. Biologics can still be administered in a majority of health and treatment conditions. With regard to cardiac-related issues such as hypertension or cardiovascular disease (CVD), there is no solid evidence that suggests biologics should be withheld, as the benefits of treatment outweigh the risks. Asthmatic patients on biologic treatment should also continue treatment if they have, or are currently being treated for, a respiratory infection, including COVID-19. Evidence also indicates the importance of maintaining asthma control to reduce the risk of severe COVID-19 infection. Biologic treatment can be administered in severe asthmatic patients with bronchiectasis, though further evidence is needed to better understand the benefits. Biologic treatment should be continued postsurgery to reduce postoperative respiratory complications, as well as throughout the course of pregnancy. Regarding concerns over vaccine administration, nearly all vaccines can be given without interruption of biologic treatment in patients with severe asthma or allergic conditions. Appropriate screening for respiratory illnesses, such as COVID-19, continues to be warranted in clinical practices to reduce the risk of transmission. As recommendations from public health and regulatory agencies have been lacking, this guidance document addresses the administration of biologics in different health circumstances and respiratory illness screening during the COVID-19 pandemic.
Competing Interests: Dr. Dorscheid is on faculty at the University of British Columbia and is supported by the following grants: Canadian Institutes of Health Research, British Columbia Lung Association, and Michael Smith Foundation for Health Research. In addition, he has received speaking fees, travel grants, unrestricted project grants, and writing fees and is a paid consultant for pharmaceutical companies, including Sanofi Regeneron, Novartis Canada, AstraZeneca, GSK, and Valeo Pharma. He is an active member of the Canadian Thoracic Society, American Thoracic Society, European Respiratory Society, and the Allergen Research Network. Dr. Dorscheid does not believe that any of the disclosed potential conflicts represent true conflicts with respect to the information and recommendations included in this manuscript. Dr. Jason K Lee is supported by the following grants: AstraZeneca, GSK, Novartis, Genentech, Regeneron, and Sanofi. In addition, he is a paid consultant to the following pharmaceutical companies: Sanofi, Regeneron, AstraZeneca, and GSK and has received speaking fees/travel grants/writing fees from Sanofi, Regeneron, GSK, AstraZeneca, and Novartis. He owns stock in Moderna. He is an active member of the American Academy of Allergy, Asthma & Immunology, the American College of Allergy, Asthma and Immunology, and the Canadian Society of Allergy and Clinical Immunology. He regularly provides consultation globally for the aforementioned organizations. Dr. Lee does not believe that any of the disclosed potential conflicts represent true conflicts with respect to the information and recommendations included in this manuscript. Dr. Ramesh is an employee of the Royal Alexandra Hospital and Edmonton Respiratory Consultants and has received speaking fees for continuing medical education events and from GSK, AstraZeneca, and Novartis. He also reports participation in advisory committees for GSK, AstraZeneca, and Sanofi. Dr. Ramesh does not believe that any of his disclosed potential conflicts represent true conflicts with respect to the information and recommendations included in this manuscript. Dr. Greenwald is an Associate Professor at Queen's University and University of Toronto and Attending Physician at Humber Regional Hospital. He also conducts a private practice dealing with allergy, asthma, and immunology. He is an active member of provincial, national, and international professional bodies in allergy and immunology. He maintains his specialist certification with the Royal College of Physicians and Surgeons of Canada. He is a consultant/speaker/advisory board member for various pharmaceutical companies, specifically relevant are AstraZeneca, Merck, Novartis, AmerisourceBergen, and Genentech. Dr. Greenwald states that none of his disclosed conflicts represent known conflicts of interest relevant to the submitted manuscript. Dr. Del Carpio is an Associate Professor of Medicine at McGill University and an Attending Physician at the McGill University Health Center Department of Allergy and Immunology and practices in his own private clinic in downtown Montreal. In addition, he is a PI/consultant/speaker and has been part of advisory boards for Stallergenes Greer, Novartis, Merck, AstraZeneca, GSK, Genentech, Circassia, Tribute/Aralez, Teva, ALK, Mylan, Pediapharm, and Covis Pharma Canada. He is an active member of the European Academy of Allergy and Clinical Immunology, American College of Allergy and Immunology, Association of Allergists and Immunologists of Quebec, Canadian Society of Allergy and Clinical Immunology, and Royal College of Physicians. Dr. Del Carpio does not believe that any of the disclosed potential conflicts represent true conflicts with respect to the information and recommendations included in this manuscript.
(Copyright © 2022 Delbert R. Dorscheid et al.)