TY - JOUR

T1 - Impact of Inititing Biologics in Patients With Severe Asthma on Long-term Oral Corticosteroids or Frequent Rescue Steroids (GLITTER)

T2 - Data From the International Severe Asthma Registry

AU - Chen, Wenjia

AU - Tran, Trung N.

AU - Sadatsafavi, Mohsen

AU - Murray, Ruth

AU - Wong, Nigel Chong Boon

AU - Ali, Nasloon

AU - Ariti, Con

AU - Bulathsinhala, Lakmini

AU - Gil, Esther Garcia

AU - FitzGerald, J. Mark

AU - Alacqua, Marianna

AU - Al-Ahmad, Mona

AU - Altraja, Alan

AU - Al-Lehebi, Riyad

AU - Bhutani, Mohit

AU - Bjermer, Leif

AU - Bjerrum, Anne Sofie

AU - Bourdin, Arnaud

AU - von Bülow, Anna

AU - Busby, John

AU - Canonica, Giorgio Walter

AU - Carter, Victoria

AU - Christoff, George C.

AU - Cosio, Borja G.

AU - Costello, Richard W.

AU - Fonseca, João A.

AU - Gibson, Peter G.

AU - Yoo, Kwang Ha

AU - Heaney, Liam G.

AU - Heffler, Enrico

AU - Hew, Mark

AU - Hilberg, Ole

AU - Hoyte, Flavia

AU - Iwanaga, Takashi

AU - Jackson, David J.

AU - Jones, Rupert C.

AU - Koh, Mariko Siyue

AU - Kuna, Piotr

AU - Larenas-Linnemann, Désirée

AU - Lehmann, Sverre

AU - Lehtimäki, Lauri

AU - Lyu, Juntao

AU - Mahboub, Bassam

AU - Maspero, Jorge

AU - Menzies-Gow, Andrew N.

AU - Newell, Anthony

AU - Sirena, Concetta

AU - Papadopoulos, Nikolaos G.

AU - Papaioannou, Andriana I.

AU - Perez-de-Llano, Luis

AU - Perng (Steve), Diahn Warng

AU - Peters, Matthew

AU - Pfeffer, Paul E.

AU - Porsbjerg, Celeste M.

AU - Popov, Todor A.

AU - Rhee, Chin Kook

AU - Salvi, Sundeep

AU - Taillé, Camille

AU - Taube, Christian

AU - Torres-Duque, Carlos A.

AU - Ulrik, Charlotte

AU - Ra, Seung Won

AU - Wang, Eileen

AU - Wechsler, Michael E.

AU - Price, David B.

N1 - Publisher Copyright: © 2023 The Authors

PY - 2023

Y1 - 2023

N2 - Background: Effectiveness of biologics has neither been established in patients with high oral corticosteroid exposure (HOCS) nor been compared with effectiveness of continuing with HOCS alone. Objective: To examine the effectiveness of initiating biologics in a large, real-world cohort of adult patients with severe asthma and HOCS. Methods: This was a propensity score–matched, prospective cohort study using data from the International Severe Asthma Registry. Between January 2015 and February 2021, patients with severe asthma and HOCS (long-term OCSs for ≥1 year or ≥4 courses of rescue OCSs within a 12-month period) were identified. Biologic initiators were identified and, using propensity scores, matched 1:1 with noninitiators. The impact of biologic initiation on asthma outcomes was assessed using generalized linear models. Results: We identified 996 matched pairs of patients. Both groups improved over the 12-month follow-up period, but improvement was greater for biologic initiators. Biologic initiation was associated with a 72.9% reduction in the average number of exacerbations per year versus noninitiators (0.64 vs 2.06; rate ratio, 0.27 [95% CI, 0.10-0.71]). Biologic initiators were 2.2 times more likely than noninitiators to take a daily long-term OCS dose of less than 5 mg (risk probability, 49.6% vs 22.5%; P = .002) and had a lower risk of asthma-related emergency department visits (relative risk, 0.35 [95% CI, 0.21-0.58]; rate ratio, 0.26 [0.14-0.48]) and hospitalizations (relative risk, 0.31 [95% CI, 0.18-0.52]; rate ratio, 0.25 [0.13-0.48]). Conclusions: In a real-world setting, including patients with severe asthma and HOCS from 19 countries, and within an environment of clinical improvement, initiation of biologics was associated with further improvements across multiple asthma outcomes, including exacerbation rate, OCS exposure, and health care resource utilization.

AB - Background: Effectiveness of biologics has neither been established in patients with high oral corticosteroid exposure (HOCS) nor been compared with effectiveness of continuing with HOCS alone. Objective: To examine the effectiveness of initiating biologics in a large, real-world cohort of adult patients with severe asthma and HOCS. Methods: This was a propensity score–matched, prospective cohort study using data from the International Severe Asthma Registry. Between January 2015 and February 2021, patients with severe asthma and HOCS (long-term OCSs for ≥1 year or ≥4 courses of rescue OCSs within a 12-month period) were identified. Biologic initiators were identified and, using propensity scores, matched 1:1 with noninitiators. The impact of biologic initiation on asthma outcomes was assessed using generalized linear models. Results: We identified 996 matched pairs of patients. Both groups improved over the 12-month follow-up period, but improvement was greater for biologic initiators. Biologic initiation was associated with a 72.9% reduction in the average number of exacerbations per year versus noninitiators (0.64 vs 2.06; rate ratio, 0.27 [95% CI, 0.10-0.71]). Biologic initiators were 2.2 times more likely than noninitiators to take a daily long-term OCS dose of less than 5 mg (risk probability, 49.6% vs 22.5%; P = .002) and had a lower risk of asthma-related emergency department visits (relative risk, 0.35 [95% CI, 0.21-0.58]; rate ratio, 0.26 [0.14-0.48]) and hospitalizations (relative risk, 0.31 [95% CI, 0.18-0.52]; rate ratio, 0.25 [0.13-0.48]). Conclusions: In a real-world setting, including patients with severe asthma and HOCS from 19 countries, and within an environment of clinical improvement, initiation of biologics was associated with further improvements across multiple asthma outcomes, including exacerbation rate, OCS exposure, and health care resource utilization.

KW - Biologics

KW - Effectiveness

KW - ISAR

KW - Oral corticosteroids

KW - Real life

U2 - 10.1016/j.jaip.2023.05.044

DO - 10.1016/j.jaip.2023.05.044

M3 - Journal article

C2 - 37301430

AN - SCOPUS:85164597997

VL - 11

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

IS - 9

ER -