Association between T2-related co-morbidities and effectiveness of biologics in severe asthma

Michael E Wechsler, Ghislaine Scelo, Désirée E.S. Larenas-Linnemann, Carlos A. Torres-Duque, Jorge F Maspero, Trung N Tran, Ruth B Murray, Neil Martin, Andrew Menzies-Gow, Mark Hew, Matthew J Peters, Peter G. Gibson, George C Christoff, Todor A Popov, Andréanne Côté, Celine Bergeron , Delbert Dorscheid, J. Mark FitzGerald, Kenneth R Chapman, Louis Philippe BouletMohit Bhutani, Libardo Jiménez-Maldonado, Mauricio Duran-Silva, Bellanid Rodriguez, Carlos Andres Celis-Preciado, Diana Jimena Cano-Rosales, Ivan Solarte, Maria Jose Fernandez-Sanchez, Patricia Parada-Tovar, Anna von Bülow, Anne Sofie Bjerrum, Charlotte Suppli Ulrik, Karin Dahl Assing, Linda Makowska Rasmussen , Susanne Hansen, Alan Altraja, Arnaud Bourdin, Camille Taillé, Jeremy Charriot, Nicolas Roche, Andriana I. Papaioannou, Konstantinos Kostikas, Nikolaos G Papadopoulos, Sundeep Salvi, Deirdre Long, Patrick Mitchell, Richard W Costello, Concetta Sirena, Cristina Cardini, Enrico Heffler, Francesca Puggioni, Giorgio Walter Canonica, Giuseppe Guida, Takashi Iwanaga, Mona Al-Ahmad, Ulises García, Piotr Kuna, João A. Fonseca, Riyad Al-Lehebi, Mariko Siyue Koh, Chin Kook Rhee, Borja G. Cosio, Luis Perez de Llano, Diahn Warng Perng, Erick Wan-Chun Huang, Hao-Chien Wang, Ming-Ju Tsai, Bassam Mahboub, Laila Ibraheem Jaber Salameh, David J Jackson, John Busby, Liam G Heaney, Paul E Pfeffer, Amanda Grippen Goddard, Eileen Wang, Flavia C.L. Hoyte, Nicholas M Chapman, Rohit Katial, Victoria Carter, Lakmini Bulathsinhala, Nevaashni Eleangovan, Con Ariti, Juntao Lyu, Celeste Porsbjerg, David Price* (Corresponding Author), Mohsen Sadatsafavi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
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Abstract

Rationale: Previous studies investigating the impact of comorbidities on the effectiveness of biologic agents have been relatively small and of short duration and have not compared classes of biologic agents.

Objectives: To determine the association between type 2–related comorbidities and biologic agent effectiveness in adults with severe asthma (SA).

Methods: This cohort study used International Severe Asthma Registry data from 21 countries (2017–2022) to quantify changes in four outcomes before and after biologic therapy—annual asthma exacerbation rate, FEV1% predicted, asthma control, and long-term oral corticosteroid daily dose—in patients with or without allergic rhinitis, chronic rhinosinusitis (CRS) with or without nasal polyps (NPs), NPs, or eczema/atopic dermatitis.

Measurements and Main Results: Of 1,765 patients, 1,257, 421, and 87 initiated anti–IL-5/5 receptor, anti-IgE, and anti–IL-4/13 therapies, respectively. In general, pre- versus post–biologic therapy improvements were noted in all four asthma outcomes assessed, irrespective of comorbidity status. However, patients with comorbid CRS with or without NPs experienced 23% fewer exacerbations per year (95% CI, 10–35%; P < 0.001) and had 59% higher odds of better post–biologic therapy asthma control (95% CI, 26–102%; P < 0.001) than those without CRS with or without NPs. Similar estimates were noted for those with comorbid NPs: 22% fewer exacerbations and 56% higher odds of better post–biologic therapy control. Patients with SA and CRS with or without NPs had an additional FEV1% predicted improvement of 3.2% (95% CI, 1.0–5.3; P = 0.004), a trend that was also noted in those with comorbid NPs. The presence of allergic rhinitis or atopic dermatitis was not associated with post–biologic therapy effect for any outcome assessed.

Conclusions: These findings highlight the importance of systematic comorbidity evaluation. The presence of CRS with or without NPs or NPs alone may be considered a predictor of the effectiveness of biologic agents in patients with SA.
Original languageEnglish
Pages (from-to)262-272
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume209
Issue number3
Early online date28 Nov 2023
DOIs
Publication statusPublished - 1 Feb 2024

Bibliographical note

Acknowledgments
The authors thank Mr. Joash Tan (BSc, Hons), of the Observational and Pragmatic Research Institute (OPRI), and Ms Andrea Lim (BSc, Hons) of the Observational Pragmatic Research Institute (OPRI) for their editorial and formatting assistance that supported the development of this publication.
Funding statement: This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. AstraZeneca UK Limited

Keywords

  • allergic rhinitis
  • chronic rhinosinusitis
  • nasal polyposis

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