CHEST Guidelines-Rebuttal-From-Dr-O’Byrne

Rebuttal-From-Dr-O’Byrne_chest

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The document includes two expert rebuttals on the use of anti-eosinophilic biologic agents for managing asthma. Dr. Paul M. O’Byrne argues in favor of these biologics like mepolizumab and reslizumab for treating severe refractory eosinophilic asthma, which persists despite high doses of conventional treatments. He acknowledges that these treatments target a smaller subset of asthma patients but highlights their significant clinical benefits, such as reducing the need for oral corticosteroids and lowering the risk of severe exacerbations. Although cost-effectiveness data are limited, O’Byrne emphasizes the potential for these biologics to provide relief for patients with this challenging condition.<br /><br />Conversely, Dr. Peter J. Barnes points out that true severe refractory asthma affects a small percentage of patients, with research indicating varied inflammation phenotypes among them. He questions the practicality of classifying these phenotypes due to the demanding nature of induced sputum analysis and the cost and availability of testing technologies, like nitric oxide analyzers. Barnes agrees that while anti-IL-5 treatments can be beneficial, they are not standalone solutions and must be combined with traditional therapies like inhaled corticosteroids. He emphasizes cost concerns, noting that these biologics are expensive and may not demonstrate cost-effectiveness, limiting their utility in practice.<br /><br />Both experts agree on the efficacy of these treatments for specific patient types but highlight different aspects, with O'Byrne focusing on the clinical advantages and Barnes on the challenges and economic implications.

Keywords

anti-eosinophilic biologics

asthma management

mepolizumab

reslizumab

severe refractory asthma

oral corticosteroids

inflammation phenotypes

cost-effectiveness

inhaled corticosteroids

clinical benefits