Association Between T2-related Comorbidities and Effectiveness of Biologics in Severe Asthma
Journal
American journal of respiratory and critical care medicine
Journal Volume
209
Journal Issue
3
Date Issued
2024-02-01
Author(s)
Wechsler, Michael E
Scelo, Ghislaine
Larenas-Linnemann, Désirée E S
Torres-Duque, Carlos A
Maspero, Jorge
Tran, Trung N
Murray, Ruth B
Martin, Neil
Menzies-Gow, Andrew N
Hew, Mark
Peters, Matthew J
Gibson, Peter G
Christoff, George C
Popov, Todor A
Côté, Andréanne
Bergeron, Celine
Dorscheid, Delbert
FitzGerald, J Mark
Chapman, Kenneth R
Boulet, Louis Philippe
Bhutani, Mohit
Sadatsafavi, Mohsen
Jiménez-Maldonado, Libardo
Duran-Silva, Mauricio
Rodriguez, Bellanid
Celis-Preciado, Carlos Andres
Cano-Rosales, Diana Jimena
Solarte, Ivan
Fernandez-Sanchez, Maria Jose
Parada-Tovar, Patricia
von Bülow, Anna
Bjerrum, Anne Sofie
Ulrik, Charlotte S
Assing, Karin Dahl
Rasmussen, Linda Makowska
Hansen, Susanne
Altraja, Alan
Bourdin, Arnaud
Taille, Camille
Charriot, Jeremy
Roche, Nicolas
Papaioannou, Andriana I
Kostikas, Konstantinos
Papadopoulos, Nikolaos G
Salvi, Sundeep
Long, Deirdre
Mitchell, Patrick D
Costello, Richard
Sirena, Concetta
Cardini, Cristina
Heffler, Enrico
Puggioni, Francesca
Canonica, Giorgio Walter
Guida, Giuseppe
Iwanaga, Takashi
Al-Ahmad, Mona
García, Ulises
Kuna, Piotr
Fonseca, João A
Al-Lehebi, Riyad
Koh, Mariko S
Rhee, Chin Kook
Cosio, Borja G
Perez de Llano, Luis
Perng, Diahn-Warng Steve
Huang, Erick Wan-Chun
Tsai, Ming-Ju
Mahboub, Bassam
Salameh, Laila Ibraheem Jaber
Jackson, David J
Busby, John
Heaney, Liam G
Pfeffer, Paul E
Goddard, Amanda Grippen
Wang, Eileen
Hoyte, Flavia C L
Chapman, Nicholas M
Katial, Rohit
Carter, Victoria
Bulathsinhala, Lakmini
Eleangovan, Neva
Ariti, Con
Lyu, Juntao
Porsbjerg, Celeste
Price, David B
Abstract
Rationale: Previous studies investigating the impact of comorbidities on the effectiveness of biologic agents have been relatively small and of short duration and have not compared classes of biologic agents. Objectives: To determine the association between type 2-related comorbidities and biologic agent effectiveness in adults with severe asthma (SA). Methods: This cohort study used International Severe Asthma Registry data from 21 countries (2017-2022) to quantify changes in four outcomes before and after biologic therapy-annual asthma exacerbation rate, FEV1% predicted, asthma control, and long-term oral corticosteroid daily dose-in patients with or without allergic rhinitis, chronic rhinosinusitis (CRS) with or without nasal polyps (NPs), NPs, or eczema/atopic dermatitis. Measurements and Main Results: Of 1,765 patients, 1,257, 421, and 87 initiated anti-IL-5/5 receptor, anti-IgE, and anti-IL-4/13 therapies, respectively. In general, pre- versus post-biologic therapy improvements were noted in all four asthma outcomes assessed, irrespective of comorbidity status. However, patients with comorbid CRS with or without NPs experienced 23% fewer exacerbations per year (95% CI, 10-35%; P < 0.001) and had 59% higher odds of better post-biologic therapy asthma control (95% CI, 26-102%; P < 0.001) than those without CRS with or without NPs. Similar estimates were noted for those with comorbid NPs: 22% fewer exacerbations and 56% higher odds of better post-biologic therapy control. Patients with SA and CRS with or without NPs had an additional FEV1% predicted improvement of 3.2% (95% CI, 1.0-5.3; P = 0.004), a trend that was also noted in those with comorbid NPs. The presence of allergic rhinitis or atopic dermatitis was not associated with post-biologic therapy effect for any outcome assessed. Conclusions: These findings highlight the importance of systematic comorbidity evaluation. The presence of CRS with or without NPs or NPs alone may be considered a predictor of the effectiveness of biologic agents in patients with SA.
Subjects
allergic rhinitis; chronic rhinosinusitis; nasal polyposis
Type
journal article