Biologicals in the treatment of severe asthma in children: A PERMEABLE assessment of the current practice in Europe

Introduction: Severe asthma is a rare disease in children and adolescents. Different biologicals are now available for asthma therapy also in children. However, even large pediatric asthma centers in Europe see and treat only a handful of these patients. Aim: To assess the current practice and approach toward the use of biological’s in children across Europe Methods: As part of PERMEABLE (PERsonalized MEdicine Approach for asthma and allergy Biologicals SeLEction) project we performed a structured interview with the heads of major pediatric asthma centers across Europe covering the following dimensions: Numbers of patients treated, national guidelines and regulations for access to treatment, selection, administration and discontinuation of biologicals, current challenges and needs. Results: We found that the number of patients treated (mainly with omalizumab) varied significantly between centers and countries (range from n= 3 to 50), with large differences between and within countries. National guidelines for administration exist in some countries but not all, and legal rules for access to biologicals vary. Most centers (64%) plan to „personalize“ future selection of biologicals but parameters for selection are not well determined. A lack of rules for deciding discontinuation of therapy became evident and a need of the centers for an international registry for biologicals in asthma therapy of children was identified. Conclusion: Our assessment across Europe shows a heterogeneous access and use of biologicals in the therapy of asthma in children and the need for sharing experience between European centers to achieve improvements in many aspects of this treatment.