Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in severe asthma patients eligible for both

paul pfeffer, Nasloon Ali, Ruth Murray, Charlotte Ulrik, Trung Tran, Jorge Maspero, Matthew Peters, George Christoff, Mohsen Sadatsafavi, Carlos A. Torres-Duque, Alan Altraja, Lauri Lehtimäki, Nikolaos Papadopoulos, Sundeep Salvi, Richard W. Costello, Breda Cushen, Enrico Heffler, Takashi Iwanaga, Mona Al-Ahmad, Désirée Larenas-LinnemannPiotr Kuna, João Fonseca, Riyad Al-Lehebi, Chin Kook Rhee, Luis Perez de Llano, Diahn-Wang Perng, Bassam Mahboub, Eileen Wang, Yun Yi Celine Goh, Juntao Lyu, Anthony Newell, Marianna Alacqua, Mohit Bhutani, Leif Bjermer, Unnur Steina Björnsdóttir, Arnaud Bourdin, Anna Von Bülow, John Busby, Walter Canonica, Borja G Cosio, Delbert Dorscheid, Mariana Muñoz Esquerre, Mark FitzGerald, Esther Garcia Gil, Peter Gerard Gibson, Liam Heaney, Mark Hew, Ole Hilberg, Flavia Hoyte, David Jackson, Mariko Koh, Hsin-Kuo Ko, Jae Ha Lee, Sverre Lehmann, Claudia Chaves Loureiro, Dora Ludviksdottir, Andrew Menzies-Gow, Patrick Mitchell, Andriana Papaioannou, Todor Popov, Celeste Porsbjerg, Laila Salameh, Concetta Sirena, Camille Taillé, Christian Taube, Yuji Tohda, M. E. Wechsler, David Price* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Patients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life.
This was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term366 oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance and hospital admissions.
In the matched analysis (n=350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p372 experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs 20.55% reduction; p=0.023).) There was some evidence to suggest that patients treated with anti374 IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43).
In real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes, however anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use.
Original languageEnglish
Number of pages15
Early online date27 Mar 2023
Publication statusE-pub ahead of print - 27 Mar 2023

Bibliographical note

In memory of Professor J. Mark Fitzgerald, the authors would like to acknowledge him for his valuable contribution to the development of the manuscript. The authors also acknowledge Ms. Daniela Morrone (MSc) of Cromsource, Verona, Italy for her contribution during the development of the manuscript and Mr. Joash Tan (BSc, Hons) of the Observational and Pragmatic Research Institute (OPRI), for editorial and formatting assistance that supported the development of this publication.

Funding information
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. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.


  • biologics
  • exacerbation
  • ISAR
  • real life
  • oral corticosteroids


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