A Multicenter Retrospective Study Evaluating IL-5-Targeted Biologic Therapies for the Treatment of Asthma and Allergic Bronchopulmonary Aspergillosis in Adults With Cystic Fibrosis
Bibliographic record
Abstract
Background Biologic therapies targeting T-helper cell type 2 (Th2) eosinophilic inflammation have been used for difficult-to-treat asthma and allergic bronchopulmonary aspergillosis (ABPA), but safety and efficacy data are limited in the cystic fibrosis (CF) population. Research Question Are Th2 biologic therapies targeting eosinophilic inflammation effective and safe when used in adults with CF with asthma and/or ABPA overlap? Study Design and Methods This was a retrospective multicenter study. Individuals with CF receiving Th2 biologic therapies for asthma or ABPA at 2 large adult CF centers between 2016 and 2021 were included. Treatment safety and effectiveness up to 12 months after biologic initiation were evaluated. Outcomes of interest included percent predicted FEV 1 (ppFEV 1 ), rate of change in ppFEV 1 , cumulative systemic corticosteroid (SCS) dose, and frequency of pulmonary exacerbations (PExs). Results Forty adults with CF received Th2 biologic therapies targeting eosinophilic inflammation during the study period. A total of 38 were eligible for study inclusion, and all received IL-5-directed therapies (mepolizumab: n=27, benralizumab: n=11): 17 (45%) for asthma only and 21 for ABPA (55%) with or without asthma. No significant biologic-related adverse effects were observed. There was no statistical difference in ppFEV 1 from baseline to 12-months postbiologic initiation, but the rate of change in ppFEV 1 improved in the 12 months postbiologic vs prebiologic with a pre-to-post difference of 3.7% (95% CI, 1.2%-6.3%). SCS dose and frequency of PExs requiring hospitalization did not differ significantly in the 12 months before biologic vs after biologic initiation. Interpretation Our results show that in adults with CF, anti-IL-5 biologic therapies were well tolerated and can improve rate of change in lung function, but there was no impact on SCS use or PEx frequency. Further study is needed to better define the role of Th2 biologics in the era of highly effective modulator therapy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".