Real world biologic use and switch patterns in severe asthma: data from the International Severe Asthma Registry and the US CHRONICLE Study

Andrew Menzies-Gow, Claire McBrien, Bindhu Unni, Celeste M. Porsbjerg, Mona Al-Ahmad, Christopher Ambrose, Karin Dahl Assing, Anna von Bülow, John Busby, Borja G. Cosio, J. Mark FitzGerald, Esther Garcia Gil, Susanne Hansen, Liam G Heaney, Mark Hew, David J Jackson, Maria Kallieri, Stelios Loukides, Njira Lugogo, Andriana I. PapaioannouDésirée Larenas-Linnemann, Wendy C. Moore, Luis Perez de Llano, Linda M. Rasmussen, Johannes Schmidt, Salman Siddiqui, Marianna Alacqua, Trung N Tran, Charlotte Suppli Ulrik, John W Upham, Wang Eileen, Lakmini Bulathsinhala, Victoria A Carter, Isha Chaudhry, Nevaashni Eleangovan, Ruth B Murray, Chris Price, David Price* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)
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Introduction: International registries provide opportunities to describe use of biologics for treating severe asthma in current clinical practice. Our aims were to describe real-life global patterns of biologic use (continuation, switches, and discontinuations) for severe asthma, elucidate reasons underlying these patterns, and examine associated patient-level factors.

Methods: This was a historical cohort study including adults with severe asthma enrolled into the International Severe Asthma Registry (ISAR;, 2015-2020) or the CHRONICLE Study (2018-2020) and treated with a biologic. Eleven countries were included (Bulgaria, Canada, Denmark, Greece, Italy, Japan, Kuwait, South Korea, Spain, UK, and (USA). Biologic utilization patterns were defined: 1) continuing initial biologic; 2) stopping biologic treatment; or 3) switching to another biologic. Reasons for discontinuation/switching were recorded and comparisons drawn between groups.
Results: 3531 patients were included. Omalizumab was the most common initial biologic in 2015 (88.2%) and benralizumab in 2019 (29.6%). Most patients (79%; 2791/3531) continued their first biologic; 10.2% (356/3531) stopped; 10.8% (384/3531) switched. The most frequent first switch was from omalizumab to an anti–IL-5/5R (49.6%; 187/377). The most common subsequent switch was from one anti–IL-5/5R to another (44.4%; 20/45). Insufficient efficacy and/or adverse effects were the most frequent reasons for stopping/switching. Patients who
stopped/switched were more likely to have a higher baseline blood eosinophil count and exacerbation rate, lower lung function, and greater health care resource utilization.

Conclusion: The description of real-life patterns of continuing, stopping, or switching biologics enhances our understanding of global biologic use. Prospective studies involving structured switching criteria could ascertain optimal strategies to identify patients who may benefit from switching.
Original languageEnglish
Pages (from-to)63-78
Number of pages16
JournalJournal of Asthma and Allergy
Publication statusPublished - 13 Jan 2022

Bibliographical note

We would like to acknowledge Dr. Ghislaine Scelo (PhD) and Dr. Nasloon Ali (PhD) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for their assistance in statistical data analysis, and Ms. Audrey Ang (BSc, Hons) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for editorial and formatting assistance that supported the development of this publication.

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.


  • Severe asthma
  • biologics
  • prescribing
  • cohort study
  • management
  • international


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