Purvi Parikh, MD: Pediatric Asthma Care with Biologics


How to weigh the 5 agents from the drug class, which have each shown differing benefit in younger patients.

The introduction of omalizumab (Xolair) to the pediatric asthma market brought a powerful biologic option to young patients not responding well enough to routine corticosteroid management. Since then, a series of other biologics have entered the space, giving physicians even more options.

In an interview with MD Magazine®, Purvi Parikh, MD, a pediatric allergist and clinical assistant professor in the Departments of Pediatrics and Medicine at NYU Langone Health, detailed the current state of care provided by biologics in pediatric asthma.

MD Mag: How do biologics particularly benefit pediatric and adolescent asthma patients?

Parikh: So, biologics have been almost a game-changer, especially for those who suffer from severe asthma, because a lot of these patients unfortunately are reliant on oral or injectable steroids throughout the years. And especially for pediatric patients, steroids come with a lot of side effects.

So, the nice thing about these biologics is that helps us minimize the use of steroids, and control their asthma better, along with other comorbid allergic illnesses. So, not only are we getting the asthma under control, but for many of these patients, we’re also getting their eczema under control, or their hives, or other things. It's kind of nice we can address multiple issues.

And it's also nice that we can control their asthma better and reduce their need for steroids.

MD Mag: Is there a standout biologic for pediatric asthma?

Parikh: So, it's very patient-dependent—just like everything else. Before, we really only had omalizumab, or Xolair, but now we have other options which is nice, because one person may react beautifully with the Xolair and are very well under control, whereas in another patient, it may not work as well for.

Also, the comorbid conditions play a role. So there's certain medicines like dupilumab which help if they have asthma and eczema, whereas omalizumab works for asthma and hives—and possibly we're seeing less reactivity in those food-allergic patients, too.

So, it's very nice that now we can kind of tailor it child-to-child, whereas before we didn't have

that option.

MD Mag: Are there set strategies in place to aid physicians in switching biologics?

Parikh: Yes, absolutely. Just like any other medication, if it's not working well and they're still having asthma attacks or flare-ups, then absolutely we do switch.

We usually give each biologic 3-6 months to take effect, because it's not meant to work acutely. It's meant to be an add-on controller medicine in addition to all the inhalers and other medicines they are taking.

So, we do have to give it some time, but we do switch if it's not working. And especially, some of the patients who had been on omalizumab—the ones doing great, we don't switch. But if they hadn't been doing great, now that new options are available, we do consider because maybe one may work better for them.

The expectations, at least from the physician standpoint, is that we should be doing a better job controlling it now that we have so many more options. Unfortunately, 10 people still die every day in this country from asthma, when that shouldn't happen at all because with all of the advances we have in medications we have.

So, at least from the physical position standpoint, the expectations are high for controlling asthma. I'm hoping now, as patients have more access to internet and TV and all of these things, that their expectations are also high for controlling it.

So, there's a big education component that if their asthma is not controlled, they should be proactive about asking the physician why and if there's other options, too.

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