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DOI 10.1016/j.chest.2026.06.076

Медицинская библиотека · Chest · 2026

Assessing the impact of earlier initiation of biologics on clinical remission and other outcomes in a global real-life severe asthma cohort from CHRONICLE, ISAR and OPCRD.

Canonica Giorgio Walter, Christoff George C, Tsai Ming-Ju, Tran Trung N, Townend John, Scelo Ghislaine, Beastall Aaron, Bulathsinhala Lakmini, Busby John, Lindsley Andrew W, Moore Wendy C, Panettieri Reynold A, Heffler Enrico, Cardini Cristina, Guida Giuseppe, Wang Eileen, Wechsler Michael E, Chapman Nicholas, Hoyte Flavia, Katial Rohit K, Otsu Kanao, Porsbjerg Celeste M, Bjerrum Anne-Sofie, von Bülow Anna, Hansen Susanne, Hilberg Ole, Julius Håkansson Kjell Erik, Søndergaard Marianne Baastrup, Ulrik Charlotte Suppli, Heaney Liam G, Jackson David J, Patel Pujan H, Pfeffer Paul E, Ryan Dermot, Kuna Piotr, Bergeron Celine, Aaron Shawn D, Abercromby Shelley, Bhutani Mohit, Chapman Kenneth R, Côté Andréanne, Davis Beth E, Dorscheid Delbert R, Hoshyari Leiana, Philipenko Brianne, Sadatsafavi Mohsen, Serajeddini Hana, Larenas-Linnemann Désirée, Cosio Borja G, Perez-de-Llano Luis, Torres-Duque Carlos A, Fernández-Sánchez María José, Garcia Elizabeth, Bolívar-Grimaldos Fabio, Jiménez-Maldonado Libardo, Cano-Rosales Diana Jimena, Solarte Ivan, Schleich Florence, Louis Renaud, Al-Lehebi Riyad, Bulkhi Adeeb A, Habis Yahya, Al-Ahmad Mona, Mahboub Bassam, Salameh Laila, Pitrez Paulo Márcio, Iwanaga Takashi, Hozawa Soichiro, Matsumoto Hisako, Nagano Tatsuya, Tajiri Tomoko, Fonseca João A, Alves da Silva Ana, Loureiro Cláudia Chaves, Cristhina de Azevedo Soares Dos Santos Hadassa, Papadopoulos Nikolaos G, Kostikas Konstantinos, Gaga Mina, Gogali Athena, Kallieri Maria, Loukides Stelios, Makris Michael, Ntakoula Maria, Papaioannou Andriana I, Paraskevopoulos Giannis, Psarros Fotios, Perng Diahn-Warng, Hsiao Yi-Han, Fu Pin-Kuei, Sheu Chau-Chyun, Aarli Bernt Bøgvald, Popov Todor A, Koh Mariko Siyue, Liew Mei Fong, Pang Pee Hwee, Lee Tan Tze, Tay Tunn Ren, Rhee Chin Kook, Máspero Jorge, Ardusso Ledit R F, Franchi María Eugenia, Sivori Martin, Stok Ana María, Yañez Anahí, Lugogo Njira, Mohan Arjun, Mitchell Patrick D, Altraja Alan, Salvi Sundeep, Costello Richard W, Denton Eve J, Hew Mark, Jenkins Christine, Langton David, Middleton Peter G, Peters Matthew J, Lehtimäki Lauri, Bourdin Arnaud, Taillé Camille, Taube Christian, Csoma Zsuzsanna, Lúdvíksdóttir Dóra, van Boven Job F M, Fingleton James, Emery Helena, Lough Graham, Perugini Valeria, Bjermer Leif, Maselli Diego J, Pleasants Roy Alton, Ambrose Christopher S, Emmanuel Benjamin, Emmas Cathy, Menzies-Gow Andrew N, Parulekar Amit D, Carter Victoria, Eleangovan Nevaashni, Murray Ruth B, Price Chris A, Blakey John D, Price David B, ISAR GLEAM Working Group

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Аннотация

BACKGROUND

Biologics are generally reserved for severe asthma (SA) after standard treatments have failed. Their recommendation is based on randomized controlled trials, designed to assess efficacy but not the optimal timing for biologic initiation.

RESEARCH QUESTION: Does the timing of biologic initiation affect SA outcomes, including remission?

STUDY DESIGN AND

METHODS

This was a cohort study using data from the International Severe Asthma Registry, the CHRONICLE US SA registry, and the UK Optimum Patient Care Research Database, together comprising data from 26 countries. The duration of time to biologic initiation was described using several proxies (e.g., duration of asthma, potential SA [PSA], lung function impairment, and frequent exacerbations, all pre-biologic). The associations between these proxies and clinical remission, exacerbations, asthma control, lung function, and oral corticosteroid (OCS) use were assessed.

RESULTS

9,241 patients were included in the association analyses. Overall, the likelihood of achieving improvement in each outcome post-biologic decreased with increasing time-to-biologic-initiation. The odds of achieving clinical remission 12-months post-biologic initiation were reduced for every 10 years patients had asthma pre-biologic (0.86 [0.84, 0.88], PSA (0.78 [0.63, 0.96]), and lung function impairment (0.24 [ 0.21, 0.28]) and for every 10 grams lifetime cumulative OCS dose (0.54 [0.30, 0.98]). For every 10-years patients had PSA pre-biologic, post-biologic exacerbation rates were 1.08 [1.03, 1.13] times higher, lung function improvement was 2.35% [-3.18, -1.51] less, and the odds of having well- or partly-controlled asthma was 12% lower (0.88 [0.53, 1.47]).

INTERPRETATION: Earlier initiation of biologics in individuals with SA is associated with better clinical outcomes, suggesting the need to modify approaches to asthma management from a 'reserve' to a 'preserve' approach: i.e., not reserving biologics for those with long-standing SA, instead preserving patients' lung function and possibly increasing the likelihood of better clinical outcomes with earlier biologic initiation.

CLINICAL TRIAL REGISTRATION: CHRONICLE - ClinicalTrials.gov identifier: NCT03373045.

Для цитирования: Canonica Giorgio Walter, Christoff George C, Tsai Ming-Ju, Tran Trung N, Townend John, Scelo Ghislaine, Beastall Aaron, Bulathsinhala Lakmini, Busby John, Lindsley Andrew W, Moore Wendy C, Panettieri Reynold A, Heffler Enrico, Cardini Cristina, Guida Giuseppe, Wang Eileen, Wechsler Michael E, Chapman Nicholas, Hoyte Flavia, Katial Rohit K, Otsu Kanao, Porsbjerg Celeste M, Bjerrum Anne-Sofie, von Bülow Anna, Hansen Susanne, Hilberg Ole, Julius Håkansson Kjell Erik, Søndergaard Marianne Baastrup, Ulrik Charlotte Suppli, Heaney Liam G, Jackson David J, Patel Pujan H, Pfeffer Paul E, Ryan Dermot, Kuna Piotr, Bergeron Celine, Aaron Shawn D, Abercromby Shelley, Bhutani Mohit, Chapman Kenneth R, Côté Andréanne, Davis Beth E, Dorscheid Delbert R, Hoshyari Leiana, Philipenko Brianne, Sadatsafavi Mohsen, Serajeddini Hana, Larenas-Linnemann Désirée, Cosio Borja G, Perez-de-Llano Luis, Torres-Duque Carlos A, Fernández-Sánchez María José, Garcia Elizabeth, Bolívar-Grimaldos Fabio, Jiménez-Maldonado Libardo, Cano-Rosales Diana Jimena, Solarte Ivan, Schleich Florence, Louis Renaud, Al-Lehebi Riyad, Bulkhi Adeeb A, Habis Yahya, Al-Ahmad Mona, Mahboub Bassam, Salameh Laila, Pitrez Paulo Márcio, Iwanaga Takashi, Hozawa Soichiro, Matsumoto Hisako, Nagano Tatsuya, Tajiri Tomoko, Fonseca João A, Alves da Silva Ana, Loureiro Cláudia Chaves, Cristhina de Azevedo Soares Dos Santos Hadassa, Papadopoulos Nikolaos G, Kostikas Konstantinos, Gaga Mina, Gogali Athena, Kallieri Maria, Loukides Stelios, Makris Michael, Ntakoula Maria, Papaioannou Andriana I, Paraskevopoulos Giannis, Psarros Fotios, Perng Diahn-Warng, Hsiao Yi-Han, Fu Pin-Kuei, Sheu Chau-Chyun, Aarli Bernt Bøgvald, Popov Todor A, Koh Mariko Siyue, Liew Mei Fong, Pang Pee Hwee, Lee Tan Tze, Tay Tunn Ren, Rhee Chin Kook, Máspero Jorge, Ardusso Ledit R F, Franchi María Eugenia, Sivori Martin, Stok Ana María, Yañez Anahí, Lugogo Njira, Mohan Arjun, Mitchell Patrick D, Altraja Alan, Salvi Sundeep, Costello Richard W, Denton Eve J, Hew Mark, Jenkins Christine, Langton David, Middleton Peter G, Peters Matthew J, Lehtimäki Lauri, Bourdin Arnaud, Taillé Camille, Taube Christian, Csoma Zsuzsanna, Lúdvíksdóttir Dóra, van Boven Job F M, Fingleton James, Emery Helena, Lough Graham, Perugini Valeria, Bjermer Leif, Maselli Diego J, Pleasants Roy Alton, Ambrose Christopher S, Emmanuel Benjamin, Emmas Cathy, Menzies-Gow Andrew N, Parulekar Amit D, Carter Victoria, Eleangovan Nevaashni, Murray Ruth B, Price Chris A, Blakey John D, Price David B, ISAR GLEAM Working Group. Assessing the impact of earlier initiation of biologics on clinical remission and other outcomes in a global real-life severe asthma cohort from CHRONICLE, ISAR and OPCRD.. Chest. 2026. DOI: 10.1016/j.chest.2026.06.076.
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