Article Dans Une Revue Allergy Année : 2024

Real‐world biologics response and super‐response in the International Severe Asthma Registry cohort

Eve Denton
Mark Hew
Matthew Peters
John Upham
Lakmini Bulathsinhala
Trung Tran
Neil Martin
Celine Bergeron
Mona Al-Ahmad
Alan Altraja
Désirée Larenas-Linnemann
Ruth Murray
Carlos Andrés Celis-Preciado
Riyad Al-Lehebi
Manon Belhassen
Mohit Bhutani
Sinthia Bosnic-Anticevich
Guy Brusselle
John Busby
Giorgio Walter Canonica
Enrico Heffler
Kenneth Chapman
  • Fonction : Auteur
Jérémy Charriot
George Christoff
Li Ping Chung
Borja Cosio
Andréanne Côté
Richard Costello
Breda Cushen
James Fingleton
João Fonseca
Peter Gibson
Liam Heaney
Erick Wan‐chun Huang
Takashi Iwanaga
David Jackson
Mariko Siyue Koh
Lauri Lehtimäki
Jorge Máspero
Bassam Mahboub
Andrew Menzies-Gow
Patrick Mitchell
Nikolaos Papadopoulos
Andriana Papaioannou
Luis Perez-De-Llano
Diahn‐warng Perng
Paul Pfeffer
Todor Popov
Celeste Porsbjerg
Chin Kook Rhee
Mohsen Sadatsafavi
Sundeep Salvi
Johannes Martin Schmid
Chau‐chyun Sheu
Concetta Sirena
Carlos Torres-Duque
Laila Salameh
  • Fonction : Auteur
Pujan Patel
  • Fonction : Auteur
Charlotte Suppli Ulrik
Eileen Wang
Michael Wechsler
David Price

Résumé

Background: Biologic asthma therapies reduce exacerbations and long‐term oral corticosteroids (LTOCS) use in randomized controlled trials (RCTs); however, there are limited data on outcomes among patients ineligible for RCTs. Hence, we investigated responsiveness to biologics in a real‐world population of adults with severe asthma. Methods: Adults in the International Severe Asthma Registry (ISAR) with ≥24 weeks of follow‐up were grouped into those who did, or did not, initiate biologics (anti‐IgE, anti‐IL5/IL5R, anti‐IL4/13). Treatment responses were examined across four domains: forced expiratory volume in 1 second (FEV 1 ) increase by ≥100 mL, improved asthma control, annualized exacerbation rate (AER) reduction ≥50%, and any LTOCS dose reduction. Super‐response criteria were: FEV 1 increase by ≥500 mL, new well‐controlled asthma, no exacerbations, and LTOCS cessation or tapering to ≤5 mg/day. Results: 5.3% of ISAR patients met basic RCT inclusion criteria; 2116/8451 started biologics. Biologic initiators had worse baseline impairment than non‐initiators, despite having similar biomarker levels. Half or more of initiators had treatment responses: 59% AER reduction, 54% FEV 1 increase, 49% improved control, 49% reduced LTOCS, of which 32%, 19%, 30%, and 39%, respectively, were super‐responses. Responses/super‐responses were more frequent in biologic initiators than in non‐initiators; nevertheless, ~40–50% of initiators did not meet response criteria. Conclusions Most patients with severe asthma are ineligible for RCTs of biologic therapies. Biologics are initiated in patients who have worse baseline impairments than non‐initiators despite similar biomarker levels. Although biologic initiators exhibited clinical responses and super‐responses in all outcome domains, 40–50% did not meet the response criteria.

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hal-04621544 , version 1 (17-10-2024)

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Eve Denton, Mark Hew, Matthew Peters, John Upham, Lakmini Bulathsinhala, et al.. Real‐world biologics response and super‐response in the International Severe Asthma Registry cohort. Allergy, 2024, 79 (10), pp.2700-2716. ⟨10.1111/all.16178⟩. ⟨hal-04621544⟩
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