Severe asthma: better guiding the therapeutic choice

Severe asthma: better guiding the therapeutic choice
Severe asthma: better guiding the therapeutic choice

In France, more than 60,000 people are affected by severe asthma. In recent years, the therapeutic offer has improved considerably with the arrival of monoclonal antibodies, biotherapies.

The RAMSES project, Research on Severe Asthma, is a prospective, multicenter, observational cohort epidemiological study that aims to assess in real life the treatment methods, benefits and/or risks associated with different treatments. Launched in 2019, and promoted by the Assistance Publique – Hôpitaux de Paris, the RAMSES cohort included 2,046 patients, followed in 52 centers across France.

By emulating a target clinical trial, it allowed for the first time to directly compare two strategies for changing biotherapy after failure of a first line with an anti IL-5 antibody: changing the class of molecule (for an anti IL-4R) or using another drug of the same class. Most patients benefit from changing the molecule, however changing the class is associated with a more marked reduction in the use of oral corticosteroids, a trend towards greater improvement in respiratory function and a decrease in exacerbations.

These data are important because they will help to better guide the therapeutic choice in the event of treatment failure.

This work follows the description of the cohort, carried out by Professor Jeanne-Marie Perotin (Reims University Hospital), published last April, which confirmed the importance of comorbidities linked to asthma and showed for the first time the heterogeneity of management of severe asthma in France, with in particular a lack of access to allergy investigations or therapeutic education. These data open up avenues of reflection to improve the management of these patients.

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