(540) United States Prescribing Trends for Biologic Agents for Children Hospitalized for Critical Asthma

Monday, February 24, 2025

9:00am – 10:00am Eastern Time

Location: Connections Central - RST 01

First Author(s)

Alexa R. Roberts, MD (she/her/hers)

St. Petersburg, Florida, United States

Co-Author(s)

Brett W. Russi, MD

University of South Florida Morsani College of Medicine
Saint Petersburg, Florida, USA
PS

Peter Scully, MD

Assistant Professor, Pediatric Critical Care Medicine. Associate Director, Pediatric Critical Care M
McGovern Medical School at UT Health, United States
JL

Jennifer W. Leiding, MD

Division of Allergy and Immunology, Department of Pediatrics
Johns Hopkins University, United States
Anthony A. Sochet, MD,

Johns Hopkins All Childrens Hospital
St Petersburg, Florida, USA

Introduction: Biologics (i.e., monoclonal antibodies) are Food and Drug Administration approved for children with moderate to severe National Heart Lung and Blood Institute (NHLBI) asthma. Prescription rates among children hospitalized with critical asthma (CA) remains ill described. We aimed to estimate prescribing rates for biologics in this population and characterize clinical and patient features for those with prescription thereof.

Methods: We performed a multicenter, retrospective cohort study using the Pediatric Health Information Systems registry including children 3-17 years of age hospitalized in 49 pediatric intensive care units for CA from January 2020 – June 2024. The primary outcome was overall and annual biologic prescription rate including antibodies for immunoglobulin-E (IgE, omalizumab), interleukin (IL)-5 (mepoluzimab and reslizumab), IL-5 receptor (IL-5R, benraluzimab), IL-4/13 (dupilumab), and thymic stromal lymphopoetin (TSLP, tezepulimab). Demographics, comorbidities, CA treatments, and inpatient outcomes were compared by cohorts defined by prescription of a biologic via summative and comparative statistics.

Results: Of 23,023 children studied, 19 were prescribed a biologic during hospitalization. The most frequently prescribed agents were anti-IL-5/5R (57.9%), anti-IgE (26.3%), and anti-IL-4/13 (15.8%). Compared to those without biologic prescription, those prescribed biologics more frequently were Black (73.7% vs 47.7%, p=0.036), reported a history of atopic dermatitis (26.4% vs 3.3% p< 0.001), classified NHLBI severe persistent asthma (47.4% vs. 11.2%, p< 0.001), and were older (median years: 13.2 [interquartile range (IQR):9.7-16.7] vs 8.1 [IQR:4.1-12.1], p< 0.001). Children prescribed biologics were observed to more frequently require bilevel positive airway pressure (57.9% vs 14.2%, p< 0.001), invasive ventilation (36.8% vs 10.9%, p=0.003), require ECMO(10.5% vs 0.3%, p=0.001), receive adjunct azithromycin (31.6% vs 13.3%, p=0.003), and had a longer median LOS (5 [IQR:3-8] vs 3 days [IQR:2-4], p< 0.001).

Conclusions: In this multicenter study, the prescription rate of biologic agents for children with CA was rare and appeared more common among children with severe asthma classification and worse clinical trajectory.