TY - JOUR
T1 - Characterization of patients in the International Severe Asthma Registry with high steroid exposure who did or did not initiate biologic therapy
AU - Chen, Wenjia
AU - Sadatsafavi, Mohsen
AU - Tran, Trung N.
AU - Murray, Ruth B.
AU - Wong, Chong Boon Nigel
AU - Ali, Nasloon
AU - Ariti, Cono
AU - Gil, Esther Garcia
AU - Newell, Anthony
AU - Alacqua, Marianna
AU - Al-Ahmad, Mona
AU - Altraja, Alan
AU - Al-Lehebi, Riyad
AU - Bhutani, Mohit
AU - Bjermer, Leif
AU - Bjerrum, Anne Sofie
AU - Bourdin, Arnaud
AU - Bulathsinhala, Lakmini
AU - Von Bülow, Anna
AU - Busby, John
AU - Canonica, Giorgio Walter
AU - Carter, Victoria
AU - Christoff, George C.
AU - Cosio, Borja G.
AU - Costello, Richard W.
AU - Fitzgerald, J. Mark
AU - Fonseca, João A.
AU - Ha Yoo, Kwang
AU - Heaney, Liam G.
AU - Heffler, Enrico
AU - Hew, Mark
AU - Hilberg, Ole
AU - Hoyte, Flavia
AU - Iwanaga, Takashi
AU - Jackson, David J.
AU - Jones, Rupert C.
AU - Koh, Mariko Siyue
AU - Kuna, Piotr
AU - Larenas-Linnemann, Désirée
AU - Lehmann, Sverre
AU - Lehtimäki, Lauri A.
AU - Lyu, Juntao
AU - Mahboub, Bassam
AU - Maspero, Jorge
AU - Menzies-Gow, Andrew N.
AU - Sirena, Concetta
AU - Papadopoulos, Nikolaos
AU - Papaioannou, Andriana I.
AU - De Llano, Luis Pérez
AU - Perng, Diahn Warng
AU - Peters, Matthew
AU - Pfeffer, Paul E.
AU - Porsbjerg, Celeste M.
AU - Popov, Todor A.
AU - Rhee, Chin Kook
AU - Salvi, Sundeep
AU - Taillé, Camille
AU - Taube, Christian
AU - Torres-Duque, Carlos A.
AU - Ulrik, Charlotte S.
AU - Won Ra, Seung
AU - Wang, Eileen
AU - Wechsler, Michael E.
AU - Price, David B.
N1 - Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2022/10/21
Y1 - 2022/10/21
N2 - Background: Many severe asthma patients with high oral corticosteroid exposure (HOCS) often do not initiate biologics despite being eligible. This study aimed to compare the characteristics of severe asthma patients with HOCS who did and did not initiate biologics. Methods: Baseline characteristics of patients with HOCS (long-term maintenance OCS therapy for at least 1 year, or ≥4 courses of steroid bursts in a year) from the International Severe Asthma Registry (ISAR; https://isaregistries.org/), who initiated or did not initiate biologics (anti-lgE, anti-IL5/5R or anti-IL4R), were described at the time of biologic initiation or registry enrolment. Statistical relationships were tested using Pearson's chi-squared tests for categorical variables, and t-tests for continuous variables, adjusting for potential errors in multiple comparisons. Results: Between January 2015 and February 2021, we identified 1412 adult patients with severe asthma from 19 countries that met our inclusion criteria of HOCS, of whom 996 (70.5%) initiated a biologic and 416 (29.5%) did not. The frequency of biologic initiation varied across geographical regions. Those who initiated a biologic were more likely to have higher blood eosinophil count (483 vs 399 cells/µL, p=0.003), serious infections (49.0% vs 13.3%, p<0.001), nasal polyps (35.2% vs 23.6%, p<0.001), airflow limitation (56.8% vs 51.8%, p=0.013), and uncontrolled asthma (80.8% vs 73.2%, p=0.004) despite greater conventional treatment adherence than those who did not start a biologic. Both groups had similar annual asthma exacerbation rates in the previous 12 months (5.7 vs 5.3, p=0.147). Conclusion: Around one third of severe HOCS asthma patients did not receive biologics despite a similar high burden of asthma exacerbations as those who initiated a biologic therapy. Other disease characteristics such as eosinophilic phenotype, serious infectious events, nasal polyps, airflow limitation and lack of asthma control appear to dictate biologic use.
AB - Background: Many severe asthma patients with high oral corticosteroid exposure (HOCS) often do not initiate biologics despite being eligible. This study aimed to compare the characteristics of severe asthma patients with HOCS who did and did not initiate biologics. Methods: Baseline characteristics of patients with HOCS (long-term maintenance OCS therapy for at least 1 year, or ≥4 courses of steroid bursts in a year) from the International Severe Asthma Registry (ISAR; https://isaregistries.org/), who initiated or did not initiate biologics (anti-lgE, anti-IL5/5R or anti-IL4R), were described at the time of biologic initiation or registry enrolment. Statistical relationships were tested using Pearson's chi-squared tests for categorical variables, and t-tests for continuous variables, adjusting for potential errors in multiple comparisons. Results: Between January 2015 and February 2021, we identified 1412 adult patients with severe asthma from 19 countries that met our inclusion criteria of HOCS, of whom 996 (70.5%) initiated a biologic and 416 (29.5%) did not. The frequency of biologic initiation varied across geographical regions. Those who initiated a biologic were more likely to have higher blood eosinophil count (483 vs 399 cells/µL, p=0.003), serious infections (49.0% vs 13.3%, p<0.001), nasal polyps (35.2% vs 23.6%, p<0.001), airflow limitation (56.8% vs 51.8%, p=0.013), and uncontrolled asthma (80.8% vs 73.2%, p=0.004) despite greater conventional treatment adherence than those who did not start a biologic. Both groups had similar annual asthma exacerbation rates in the previous 12 months (5.7 vs 5.3, p=0.147). Conclusion: Around one third of severe HOCS asthma patients did not receive biologics despite a similar high burden of asthma exacerbations as those who initiated a biologic therapy. Other disease characteristics such as eosinophilic phenotype, serious infectious events, nasal polyps, airflow limitation and lack of asthma control appear to dictate biologic use.
KW - Biologics
KW - Patient characteristics
KW - Real-world
KW - Severe asthma
KW - Treatment pattern
UR - http://www.scopus.com/inward/record.url?scp=85141030684&partnerID=8YFLogxK
U2 - 10.2147/JAA.S377174
DO - 10.2147/JAA.S377174
M3 - Article
C2 - 36303891
AN - SCOPUS:85141030684
SN - 1178-6965
VL - 15
SP - 1491
EP - 1510
JO - Journal of Asthma and Allergy
JF - Journal of Asthma and Allergy
ER -