Severe Asthma Patients' Characteristics in Mexico Versus International Severe Asthma Registry (ISAR) Global.

PURPOSE OF REVIEW: The International Severe Asthma (SA) Registry (ISAR) started in 2017. Mexico joint in 2019. ISAR global patients have been well characterized in several publications. However, local patients may differ from the global picture, which could in the future result in a different effectiveness and safety profile with biologics. Our purpose is to compare pre-biologic initiation data from the Mexican ISAR patients against global and compare characteristics among the Mexican patients of (i) those started on biologic therapy versus non-initiators, and (ii) ever smokers versus non-smokers. RECENT FINDINGS: From 17,567 ISAR-Global and 438 ISAR-Mexico patients, 16,269 (92.6%) and 348 (79.5%) were eligible; 11% of Mexicans were minors and excluded. Mexican patients were younger, more often female and never-smokers. Biologic use was higher in Mexico (79%; predominantly omalizumab 74%), whereas < 50% of Global started biologics, with anti-IL-5/5R most used. Age at asthma onset was similar (30–31 y), but disease duration was shorter in Mexico (median 15 versus 18y). At baseline, Mexican patients had more exacerbations (all exacerbation metrics were higher), worse control, but lower LTOCS exposure and less frequent low lung function. Allergic sensitization was more frequent in Mexico (~ 80% vs. ~ 67%), especially to house-dust mite (64% vs. 35%). Type-2 comorbidities were more common and numerous in Mexico; OCS-related comorbidities were more prevalent globally. Obesity tended to be higher in Mexico. Mexican biologic initiators vs. non-initiators were younger, more often female/obese, with later onset, shorter duration, more exacerbations, fewer LTOCS users, more eosinophilic inflammation, and less sleep apnea/anxiety. Ever-smokers had poorer control, higher FeNO, more T2 comorbidities (CRS, NP, AD), and more obesity/diabetes/embolism. The profile of local SA patients can differ from global. Mexican ISAR patients have several characteristics that relate to a higher probability of response to biologic therapy versus global.