TY - JOUR

T1 - Comparative effectiveness of anti-IL5 and anti-IgE biologic classes in patients with severe asthma eligible for both

AU - Pfeffer, Paul E.

AU - Ali, Nasloon

AU - Murray, Ruth

AU - Ulrik, Charlotte

AU - Tran, Trung N.

AU - Maspero, Jorge

AU - Peters, Matthew

AU - Christoff, George C.

AU - Sadatsafavi, Mohsen

AU - Torres-Duque, Carlos A.

AU - Altraja, Alan

AU - Lehtimäki, Lauri

AU - Papadopoulos, Nikolaos G

AU - Salvi, Sundeep

AU - Costello, Richard W.

AU - Cushen, Breda

AU - Heffler, Enrico

AU - Iwanaga, Takashi

AU - Al-Ahmad, Mona

AU - Larenas-Linnemann, Désirée

AU - Kuna, Piotr

AU - Fonseca, João A.

AU - Al-Lehebi, Riyad

AU - Rhee, Chin Kook

AU - Perez-de-Llano, Luis

AU - Perng Steve, Diahn Warng

AU - Mahboub, Bassam

AU - Wang, Eileen

AU - Goh, Celine

AU - Lyu, Juntao

AU - Newell, Anthony

AU - Alacqua, Marianna

AU - Belevskiy, Andrey S.

AU - Bhutani, Mohit

AU - Bjermer, Leif

AU - Bjornsdottir, Unnur

AU - Bourdin, Arnaud

AU - Bulow, Anna von

AU - Busby, John

AU - Canonica, Giorgio Walter

AU - Cosio, Borja G.

AU - Dorscheid, Delbert R.

AU - Muñoz-Esquerre, Mariana

AU - FitzGerald, J. Mark

AU - Gil, Esther Garcia

AU - Gibson, Peter G.

AU - Heaney, Liam G.

AU - Hew, Mark

AU - Hilberg, Ole

AU - Hoyte, Flavia

AU - Jackson, David J.

AU - Koh, Mariko Siyue

AU - Ko, Hsin Kuo Bruce

AU - Lee, Jae Ha

AU - Lehmann, Sverre

AU - Chaves Loureiro, Cláudia

AU - Lúðvíksdóttir, Dóra

AU - Menzies-Gow, Andrew N.

AU - Mitchell, Patrick

AU - Papaioannou, Andriana I.

AU - Popov, Todor A.

AU - Porsbjerg, Celeste M.

AU - Salameh, Laila

AU - Sirena, Concetta

AU - Taillé, Camille

AU - Taube, Christian

AU - Tohda, Yuji

AU - Wechsler, Michael E.

AU - Price, David B.

N1 - Publisher Copyright: © 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

PY - 2023

Y1 - 2023

N2 - Background: Patients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life. Methods: This was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term-oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance, and hospital admissions. Results: In the matched analysis (n = 350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p < 0.001) and experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs. 20.55% reduction; p = 0.023). There was some evidence to suggest that patients treated with anti-IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43). Conclusions: In real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes; however, anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use.

AB - Background: Patients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life. Methods: This was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term-oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance, and hospital admissions. Results: In the matched analysis (n = 350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p < 0.001) and experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs. 20.55% reduction; p = 0.023). There was some evidence to suggest that patients treated with anti-IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43). Conclusions: In real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes; however, anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use.

KW - biologics

KW - exacerbation

KW - ISAR

KW - oral corticosteroids

KW - real life

U2 - 10.1111/all.15711

DO - 10.1111/all.15711

M3 - Journal article

C2 - 36929509

AN - SCOPUS:85151412409

VL - 78

SP - 1934

EP - 1948

JO - Allergy: European Journal of Allergy and Clinical Immunology

JF - Allergy: European Journal of Allergy and Clinical Immunology

SN - 0105-4538

IS - 7

ER -