An international study has found widespread agreement that pregnant women with severe asthma can be treated with biologics.
Biologics are antibody-based treatments that are usually given as an injection.
The research sought to reach a consensus among those who treat patients with severe asthma.
It was led by Dr Hitasha Rupani, Consultant Respiratory Physician at University Hospital Southampton and part of the NIHR Southampton Biomedical Research Centre.
Researchers have published their findings in The Lancet Respiratory Medicine.
Asthma and pregnancy
Asthma is the most common medical condition during pregnancy. It is very important for women with severe asthma to control it well during pregnancy.
This is because uncontrolled asthma is associated with an increased risk of complications in pregnancy and birth. These include pre-eclampsia, premature labour and low birthweight.
However, asthma symptoms can change in pregnancy. This means some women find their symptoms get worse, and they need extra treatments to keep their asthma under control.
Steroid tablets are the standard treatment for asthma attacks. However, these can have numerous side-effects, both for the mother and the baby.
Biologics as an alternative
Asthma biologics improve asthma control and reduce the frequency of asthma attacks, without having any of the side effects associated with steroid tablets.
These treat some types of severe asthma by helping to stop body processes that cause lung inflammation.
They are widely used in non-pregnant people and help to bring the person’s symptoms back under control. Pregnant women did not take part in the clinical trials of asthma biologics. This means there is a lack of clear evidence on their safety in pregnancy.
However, early data from monitoring women who have taken biologics in pregnancy has not found an association with an increased risk of complications.
Reaching a consensus
Dr Rupani aimed to provide guidance on whether to prescribe biologics to pregnant women with severe asthma.
She led an international study that asked relevant experts for their professional opinion. This drew upon their combined knowledge and experience. Known as a Delphi study, it used a systematic and structured process to help them reach a consensus.
Overall, 141 experts from 32 countries completed two rounds of online surveys. All of them cared for patients with severe asthma. They included respiratory physicians, allergists, specialist nurses, pharmacists and obstetricians.
They reached a consensus for 34 of 69 statements. These covered the use of asthma biologics during conception, pregnancy, and breastfeeding.
They agreed that asthma biologics:
do not need to be stopped while patients are trying to conceive
can be continued throughout pregnancy
can be started during pregnancy in line with national prescribing criteria, especially in people with frequent exacerbations (four or more in a 12-month period)
can be started and continued while breastfeeding
It was also agreed that asthma-related admissions to hospital and steroid side effects should lower the threshold for starting biologics.
They emphasised that shared decision-making should underpin all decisions regarding the use of biologics in pregnancy and that it is also important to discuss potential risks and benefits with each patient.
Dr Rupani said: “Due to the lack of evidence from randomised-controlled trials, there is huge variation and hesitancy in the use of asthma biologics in pregnancy. However, asthma biologics are fantastic at improving asthma control and reducing the use of oral steroids - treatments that have numerous, serious side effects.
“It is important that pregnant women do not miss out from receiving asthma biologics, simply because they weren’t included in the clinical trials.
“Therefore, it is excellent that a group of international clinical experts agreed that, provided potential risks and benefits had been discussed and basic asthma care optimised, asthma biologics can be initiated and/or continued during conception, pregnancy and breastfeeding.
"We hope the results of our study will help shared decision-making and reduce variations in care.”
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