Prevention of Cardiovascular and Other Systemic Adverse Outcomes in Patients with Asthma Treated with Biologics.
Journal
American journal of respiratory and critical care medicine
Journal Volume
211
Journal Issue
7
Start Page
1165
End Page
1174
ISSN
1535-4970
Date Issued
2025-07
Author(s)
Sadatsafavi, Mohsen
Tran, Trung N
Scelo, Ghislaine
Tsai, Ming-Ju
Busby, John
Emmanuel, Benjamin
Heaney, Liam G
Jenkins, Christine
Hoyte, Flavia
Canonica, Giorgio Walter
Katial, Rohit
Heffler, Enrico
Wang, Eileen
Puggioni, Francesca
Wechsler, Michael E
Ardusso, Ledit R F
Máspero, Jorge
Sivori, Martin
Emmas, Cathy
Menzies-Gow, Andrew N
Stjepanovic, Neda
Bosnic-Anticevich, Sinthia Z
Cochrane, Belinda
Denton, Eve
Gibson, Peter G
Hew, Mark
Middleton, Peter G
Peters, Matthew J
Brusselle, Guy G
Louis, Renaud
Schleich, Florence
Christoff, George C
Popov, Todor A
Bergeron, Celine
Bhutani, Mohit
Chapman, Kenneth R
Côté, Andréanne
Couillard, Simon
Dorscheid, Delbert R
Jiménez-Maldonado, Libardo
Solarte, Ivan
Torres-Duque, Carlos A
Hansen, Susanne
Porsbjerg, Celeste M
Ulrik, Charlotte Suppli
Altraja, Alan
Bourdin, Arnaud
Exarchos, Konstantinos P
Gogali, Athena
Kostikas, Konstantinos
Makris, Michael P
Papaioannou, Andriana I
Mitchell, Patrick D
Iwanaga, Takashi
Nagano, Tatsuya
Tohda, Yuji
Al-Ahmad, Mona S
Larenas-Linnemann, Désirée
Aarli, Bernt Bøgvald
Kuna, Piotr
Chaves Loureiro, Cláudia
Al-Lehebi, Riyad
Bulkhi, Adeeb A
Chen, Wenjia
Juang, Yah Ru
Koh, Mariko Siyue
Liu, Anqi
Rhee, Chin Kook
Cosio, Borja G
Perez-de-Llano, Luis
Perng, Diahn-Warng
Sheu, Chau-Chyun
Mahboub, Bassam
Salameh, Laila
Jackson, David J
Patel, Pujan H
Pfeffer, Paul E
Lugogo, Njira
Pleasants, Roy Alton
Beastall, Aaron
Bulathsinhala, Lakmini
Carter, Victoria
Eleangovan, Nevaashni
Fletton, Kirsty
Townend, John
Murray, Ruth B
Price, David B
Abstract
Although clinical trials have documented the oral corticosteroid (OCS)-sparing effect of biologics in patients with severe asthma, little is known about whether this translates to a reduction of new-onset OCS-related adverse outcomes. To compare the risk of developing new-onset OCS-related adverse outcomes between biologic initiators and noninitiators. This was a longitudinal cohort study using pooled data from the International Severe Asthma Registry (ISAR; 16 countries) and the Optimum Patient Care Research database (OPCRD; United Kingdom). For biologic initiators, the index date was the date of biologic initiation. For noninitiators, it was the date of enrollment (for ISAR) or a random medical appointment date (for OPCRD). Inverse probability of treatment weighting was used to improve comparability between groups, and weighted Cox proportional hazard models were used to estimate the hazard ratios (HRs) of developing OCS-related adverse outcomes for up to 5 years from the index date. A total of 42,908 patients were included. Overall, 27.3% and 4.7% of biologic initiators and noninitiators were long-term OCS users (daily intake ⩾90 consecutive days in year before the index date), with a mean prednisolone-equivalent daily dose of 10.2 mg and 6.2 mg, respectively. Compared with noninitiators, biologic initiators had decreased rate of developing any OCS-related adverse outcome (HR [95% confidence interval (CI)]: 0.82 [0.72-0.93]; = 0.002), primarily driven by reduced rate of developing diabetes (0.62 [0.45-0.87]; = 0.006), major cardiovascular events (0.65 [0.44-0.97]; = 0.034), and anxiety and/or depression (0.68 [0.55-0.85]; = 0.001). There were no significant differences in the rates of new-onset cataract (HR, 0.77 [95% CI, 0.47-1.25]), sleep apnea (HR, 0.82 [95% CI, 0.78-1.41]), or other OCS-related adverse outcomes assessed (e.g., osteoporosis). The results were consistent across both datasets. Our findings highlight the role for biologics in preventing new-onset OCS-related adverse outcomes in patients with severe asthma.
Subjects
adverse cardiac event
cohort studies
diabetes mellitus
SDGs
Type
journal article