Abstract
RATIONALE: T2-related comorbidities are common in patients with severe asthma, particularly allergic rhinitis (AR), chronic rhinosinusitis (CRS), nasal polyposis (NP), and atopic dermatitis (AD), and are known to be associated with worse asthma outcomes. Whether they impact the effectiveness of biologics is understudied. The aim of this study was to determine the association between T2-related comorbidities and effectiveness of biologics in adult patients with severe asthma.
METHODS: We designed a registry-based cohort study using data from the International Severe Asthma Registry (ISAR; https://isaregistries.org/). A total of 1769 patients from 21 countries who initiated anti-IL5/5R (n=1261), anti-IgE (n=421), or antiIL4/13 (n=87) therapies between 01/05/2017 and 24/01/2022 were included in the study. Effectiveness of biologics (overall, and by biologic class where numbers allowed: anti-IL5/5R and anti-IgE) was measured up to approximately 1 year following biologic initiation for each of four asthma related outcomes: exacerbation rate, % predicted FEV1, asthma control, and long-term oral corticosteroids (LTOCS) daily dose. Using regression models, we compared pre- to post biologic improvements in each of these outcomes in patients with and without an individual T2-related comorbidity. RESULTS: Patients treated with a biologic showed significant improvement in all asthma-related outcomes, irrespective of the presence of comorbidity. However, more improvements were noted in patients with comorbid AR, CRS, or NP than in those without. Moreover, the impact of comorbidity on biologic effectiveness varied by biologic class. For anti-IgE patients, having AR was associated with a greater reduction in exacerbation rates and greater likelihood of well- or partly-controlled asthma, compared to patients without AR (Table). For antiIL5/5R patients, AR, CRS, and NP were associated with greater biologic effectiveness: AR, CRS, and NP were associated with a greater reduction in exacerbation rates and enhanced improvement in and asthma control. AR and CRS were also associated with an enhanced improvement of % predicted FEV1 (Table). None of the assessed T2-related comorbidities were found to be associated with a larger reduction in daily LTOCS dose, and AD was not associated with any of the studied outcomes.
CONCLUSIONS: Despite increased risk associated with T2 related comorbidities, patients with AR, CRS, and NP tend to experience an enhanced response to biologics. The enhanced biologic effectiveness is more apparent in patients initiating antiIL5/5R rather than anti-IgE. These findings highlight the importance of systematic evaluation for comorbidities and indicate that the presence of T2-related comorbidities could be used as a predictor of higher biologic effectiveness.
METHODS: We designed a registry-based cohort study using data from the International Severe Asthma Registry (ISAR; https://isaregistries.org/). A total of 1769 patients from 21 countries who initiated anti-IL5/5R (n=1261), anti-IgE (n=421), or antiIL4/13 (n=87) therapies between 01/05/2017 and 24/01/2022 were included in the study. Effectiveness of biologics (overall, and by biologic class where numbers allowed: anti-IL5/5R and anti-IgE) was measured up to approximately 1 year following biologic initiation for each of four asthma related outcomes: exacerbation rate, % predicted FEV1, asthma control, and long-term oral corticosteroids (LTOCS) daily dose. Using regression models, we compared pre- to post biologic improvements in each of these outcomes in patients with and without an individual T2-related comorbidity. RESULTS: Patients treated with a biologic showed significant improvement in all asthma-related outcomes, irrespective of the presence of comorbidity. However, more improvements were noted in patients with comorbid AR, CRS, or NP than in those without. Moreover, the impact of comorbidity on biologic effectiveness varied by biologic class. For anti-IgE patients, having AR was associated with a greater reduction in exacerbation rates and greater likelihood of well- or partly-controlled asthma, compared to patients without AR (Table). For antiIL5/5R patients, AR, CRS, and NP were associated with greater biologic effectiveness: AR, CRS, and NP were associated with a greater reduction in exacerbation rates and enhanced improvement in and asthma control. AR and CRS were also associated with an enhanced improvement of % predicted FEV1 (Table). None of the assessed T2-related comorbidities were found to be associated with a larger reduction in daily LTOCS dose, and AD was not associated with any of the studied outcomes.
CONCLUSIONS: Despite increased risk associated with T2 related comorbidities, patients with AR, CRS, and NP tend to experience an enhanced response to biologics. The enhanced biologic effectiveness is more apparent in patients initiating antiIL5/5R rather than anti-IgE. These findings highlight the importance of systematic evaluation for comorbidities and indicate that the presence of T2-related comorbidities could be used as a predictor of higher biologic effectiveness.
| Original language | English |
|---|---|
| Number of pages | 2 |
| Publication status | Published - 23 May 2023 |
| Event | 2023 ATS International Conference - Washington, D.C. , Washington D.C. , UNITED STATES Duration: 19 May 2023 → 24 May 2023 https://conference.thoracic.org/ |
Conference
| Conference | 2023 ATS International Conference |
|---|---|
| Country/Territory | UNITED STATES |
| City | Washington D.C. |
| Period | 19/05/23 → 24/05/23 |
| Internet address |