Asthma phenotyping in primary care: applying the International Severe Asthma Registry eosinophil phenotype algorithm across all asthma severities.

Marjan Kerkhof, Trung N Tran, Riyad Alleheb, G Walter Canonica, Liam G Heaney, Mark Hew, Luis Perez de Llano, Michael E Wechsler, Lakmini Bulathsinhala, Victoria A. Carter, Isha Chaudhry, Neva Eleangovan, Ruth B Murray, Chris A. Price, David B. Price* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
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Abstract

Background: An eosinophil phenotype gradient algorithm has been developed and applied to a large severe asthma cohort (International Severe Asthma Registry; ISAR).

Objective: We sought to re-apply this algorithm in a UK primary care asthma cohort, quantify the eosinophilic phenotype and, assess the relationship between likelihood of eosinophilic phenotype and asthma severity/healthcare resource utilization (HCRU).

Methods: Patients (≥13 years old) with active asthma and ≥1 blood eosinophil count included from the Optimum Patient Care Research Database and the Clinical Practice Research Datalink, were categorized according to the likelihood of eosinophilic phenotype using the ISAR gradient eosinophilic algorithm. Patient demographic, clinical and HCRU characteristics were described for each phenotype.

Results: Of 241,006 patients, 50.3%, 22.2% and 21.9% “most likely” (Grade 3), “likely” (Grade 2), and “least likely” (Grade 1) had an eosinophilic phenotype respectively, and 5.6% had a non-eosinophilic phenotype (Grade 0). Compared to patients with non-eosinophilic asthma, those “most likely” to have an eosinophilic phenotype tended to have more co-morbidities (% with Charlson co-morbidity index ≥2: 28.2% vs 6.9%) and experienced more asthma attacks (% with ≥1 attack: 24.8% vs 15.3%). These patients were also more likely to have difficult-to-treat asthma (31.1% vs 18.3%), receive more intensive treatment (% on GINA (2020) Step 4 or 5: 44.2% vs 27.5%), and greater HCRU (e.g. 10.8 vs 7.9 GP all-cause consultations/year).

Conclusion: The eosinophilic asthma phenotype predominates in primary care and is associated with greater asthma severity and HCRU. These patients may benefit from earlier and targeted asthma therapy.
Original languageEnglish
Pages (from-to)4353-4370
Number of pages18
JournalThe Journal of Allergy and Clinical Immunology: In Practice
Volume9
Issue number12
Early online date14 Aug 2021
DOIs
Publication statusPublished - 1 Dec 2021

Bibliographical note

Funding Information:
The Optimum Patient Care Research Database is established and maintained by Optimum Patient Care (OPC) Ltd. This study was funded by AstraZeneca and conducted collaboratively with the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and OPC Global Ltd.Conflicts of interest: M. Kerkhof, L. Bulathsinhala, I. Chaudhry, and N. Eleangovan were employees of OPRI at the time of the study, which conducted this study in collaboration with OPC and AstraZeneca. V.A. Carter and C.A. Price are employees of OPC Global Ltd, which conducted this study in collaboration with OPRI and AstraZeneca. T.N. Tran is an employee of AstraZeneca, which is the funder of this study. R. Al-Lehebi has given lectures at meetings supported by AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, and Sanofi and participated in advisory board fees from GlaxoSmithKline and Sanofi. G.W. Canonica has received research grants as well as lecture or advisory board fees from A. Menarini, Alk-Albello, Allergy Therapeutics, Anallergo, AstraZeneca, MedImmune, Boehringer Ingelheim, Chiesi Farmaceutici, Circassia, Danone, Faes, Genentech, Guidotti Malesci, GlaxoSmithKline, Hal Allergy, Merck, MSD, Mundipharma, Novartis, Orion, Sanofi Aventis, Sanofi, Genzyme/Regeneron, Stallergenes, UCB Pharma, Uriach Pharma, Teva, Thermo Fisher, and Valeas. L.G. Heaney has received grant funding, participated in advisory boards, and given lectures at meetings supported by MedImmune, Novartis, Genentech/Hoffman Roche, GlaxoSmithKline, Evelo Biosciences, Sanofi AstraZeneca, Teva, Theravance, and Circassia; has taken part in asthma clinical trials sponsored by Boehringer Ingelheim, Hoffmann la Roche, and GlaxoSmithKline, for which his institution received remuneration; and is the academic lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma, which involves industrial partnerships with a number of pharmaceutical companies including Amgen, AstraZeneca, Medimmune, Genentech/Hoffman LaRoche, GlaxoSmithKline, Circassia, Vitalograph, and Boehringer Ingelheim. M. Hew declares grants and other advisory board fees (made to his institutional employer) from AstraZeneca, GlaxoSmithKline, Novartis, and Seqirus, for unrelated projects. L. Perez de Llano declares nonfinancial support, personal fees, and grants from Teva; nonfinancial support and personal fees from Boehringer Ingelheim, Esteve, GlaxoSmithKline, Mundipharma, and Novartis; personal fees and grants from AstraZeneca and Chiesi; and personal fees from Sanofi; and nonfinancial support from Menairi outside the submitted work. M.E. Wechsler reports receiving consulting honoraria from AstraZeneca, Boehringer Ingelheim, Cohero Health, Equillium, Genentech, GSK, Novartis, Regeneron, Sanofi Genzyme, and Teva. D.B. Price has board memberships with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Teva Pharmaceuticals, Thermo Fisher; consultancy agreements with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mylan, Mundipharma, Novartis, Pfizer, Teva Pharmaceuticals, and Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through OPRI Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mylan, Mundipharma, Novartis, Pfizer, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Teva Pharmaceuticals, Theravance, and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mylan, Mundipharma, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, and Teva Pharmaceuticals; payment for the development of educational materials from Mundipharma and Novartis; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, Novartis, and Thermo Fisher; funding for patient enrolment or completion of research from Novartis; and stock/stock options from AKL Research and Development Ltd, which produces phytopharmaceuticals; owns 74% of the social enterprise OPC Ltd (Australia and UK) and 74% of OPRI Pte Ltd (Singapore); and 5% shareholding in Timestamp, which develops adherence monitoring technology; is a peer reviewer for grant committees of the Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. The rest of the authors declare that they have no relevant conflicts of interest.

Funding Information:
The OPCRD is established and maintained by Optimum Patient Care Ltd. This study was funded by AstraZeneca and conducted by the Observational and Pragmatic Research Institute Pte Ltd. The Observational and Pragmatic Research Institute Pte Ltd, Optimum Patient Care, and AZ members of the ISAR Steering Committee had input into the study design, data analysis and interpretation, and manuscript writing, and are authors of this article in line with International Committee of Medical Journal Editors author criteria.

Funding Information:
The Optimum Patient Care Research Database is established and maintained by Optimum Patient Care (OPC) Ltd. This study was funded by AstraZeneca and conducted collaboratively with the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and OPC Global Ltd .

Publisher Copyright:
© 2021 The Authors

Keywords

  • asthma
  • eosinophilic
  • healthcare resource utilization
  • ISAR
  • phenotypes
  • Primary care
  • severity
  • UK

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