Characterization of Patients in the International Severe Asthma Registry with High Steroid Exposure Who Did or Did Not Initiate Biologic Therapy.
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Chen Wenjia, Sadatsafavi Mohsen, Tran Trung N, Murray Ruth B, Wong Chong Boon Nigel, Ali Nasloon, Ariti Cono, Garcia Gil Esther, Newell Anthony, Alacqua Marianna, Al-Ahmad Mona, Altraja Alan, Al-Lehebi Riyad, Bhutani Mohit, Bjermer Leif, Bjerrum Anne Sofie, Bourdin Arnaud, Bulathsinhala Lakmini, von Bülow Anna, Busby John, Canonica Giorgio Walter, Carter Victoria, Christoff George C, Cosio Borja G, Costello Richard W, FitzGerald J Mark, Fonseca João A, Yoo Kwang Ha, Heaney Liam G, Heffler Enrico, Hew Mark, Hilberg Ole, Hoyte Flavia, Iwanaga Takashi, Jackson David J, Jones Rupert C, Koh Mariko Siyue, Kuna Piotr, Larenas-Linnemann Désirée, Lehmann Sverre, Lehtimäki Lauri A, Lyu Juntao, Mahboub Bassam, Maspero Jorge, Menzies-Gow Andrew N, Sirena Concetta, Papadopoulos Nikolaos, Papaioannou Andriana I, Pérez de Llano Luis, Perng Diahn-Warng, Peters Matthew, Pfeffer Paul E, Porsbjerg Celeste M, Popov Todor A, Rhee Chin Kook, Salvi Sundeep, Taillé Camille, Taube Christian, Torres-Duque Carlos A, Ulrik Charlotte S, Ra Seung Won, Wang Eileen, Wechsler Michael E, Price David B
Аннотация
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.