Abstract
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 language | English |
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Pages (from-to) | 262-272 |
Number of pages | 11 |
Journal | American Journal of Respiratory and Critical Care Medicine |
Volume | 209 |
Issue number | 3 |
Early online date | 28 Nov 2023 |
DOIs | |
Publication status | Published - 1 Feb 2024 |
Bibliographical note
AcknowledgmentsThe 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