The following is a summary of “Comparing bronchial thermoplasty with biologicals for severe asthma: Systematic review and network meta-analysis,” published in the SEPTEMBER 2023 issue of Pulmonology by Fong, et al.

Bronchial thermoplasty (BT) has demonstrated positive safety and efficacy results in several randomized controlled trials (RCTs), but its direct comparison with biological therapies has not been investigated.

A systematic search was conducted on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials to identify RCTs that evaluated BT or FDA-approved biologicals compared to controls in patients with severe asthma. Six outcome measures were analyzed: the Asthma Control Questionnaire (ACQ), the Asthma Quality of Life Questionnaire (AQLQ), the incidence of asthma exacerbation, annualized exacerbation rate ratio (AERR), oral corticosteroid dose reduction (OCDR), and morning peak expiratory flow rate (amPEF). Random-effects, Frequentist network meta-analysis (NMA) was performed, and therapies were ranked using P-scores.

A total of 29 RCTs involving 15,547 patients were included in the analysis. Compared to the control group, patients treated with BT had a lower incidence of asthma exacerbation (risk ratio [RR] = 0.66, 95% CI = 0.45–0.98). Although the AERR between BT and control was not significant, significant improvements were observed in ACQ score (mean difference [MD] −0.41, 95% CI -0.63 to −0.20), AQLQ score (MD = 0.54, 95% CI = 0.30–0.77), amPEF, and OCDR. Indirect comparisons did not reveal significant differences between BT and biological therapies.

Despite the absence of head-to-head comparative trials, the network meta-analysis suggested that BT is comparable to biological therapies in terms of improving quality-of-life scores. BT presents itself as a promising alternative for patients with severe asthma.

Source: resmedjournal.com/article/S0954-6111(23)00190-7/fulltext