Exploring Definitions and Predictors of Response to Biologics for Severe Asthma.

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • João De Almeida Lopes Da Fonseca

    Autor

Participantes de fora da FMUP

  • Scelo G
  • Tran TN
  • Le TT
  • Fagerås M
  • Dorscheid D
  • Busby J
  • Al-Ahmad M
  • Al-Lehebi R
  • Altraja A
  • Beastall A
  • Bergeron C
  • Bjermer L
  • Bjerrum AS
  • Cano-Rosales DJ
  • Canonica GW
  • Carter V
  • Charriot J
  • Christoff GC
  • Cosio BG
  • Denton E
  • Fernandez-Sanchez MJ
  • Gibson PG
  • Goh C
  • Heaney LG
  • Heffler E
  • Hew M
  • Iwanaga T
  • Katial R
  • Koh MS
  • Kuna P
  • Larenas-Linnemann D
  • Lehtimäki L
  • Mahboub B
  • Martin N
  • Matsumoto H
  • Menzies-Gow AN
  • Papadopoulos NG
  • Patel P
  • Perez-De-Llano L
  • Peters M
  • Pfeffer PE
  • Popov TA
  • Porsbjerg CM
  • Rhee CK
  • Sadatsafavi M
  • Taillé C
  • Torres-Duque CA
  • Tsai MJ
  • Ulrik CS
  • Upham JW
  • von Bülow A
  • Wang E
  • Wechsler ME
  • Price DB

Unidades de investigação

Abstract

BACKGROUND: Biologic effectiveness is often assessed as response, a term that eludes consistent definition. Identifying those most likely to respond in real-life has proven challenging. OBJECTIVE: To explore definitions of biologic responders in adults with severe asthma and investigate patient characteristics associated with biologic response. METHODS: This was a longitudinal cohort study using data from 21 countries, which shared data with the International Severe Asthma Registry. Changes in four asthma outcome domains were assessed in the 1-year period before and after biologic initiation in patients with a predefined level of prebiologic impairment. Responder cutoffs were 50% or greater reduction in exacerbation rate, 50% or greater reduction in long-term oral corticosteroid daily dose, improvement in one or more category in asthma control, and 100 mL or greater improvement in FEV(1). Responders were defined using single and multiple domains. The association between prebiologic characteristics and postbiologic initiation response was examined by multivariable analysis. RESULTS: A total of 2,210 patients were included. Responder rate ranged from 80.7% (n = 566 of 701) for exacerbation response to 10.6% (n = 9 of 85) for a four-domain response. Many responders still exhibited significant impairment after biologic initiation: 46.7% (n = 206 of 441) of asthma control responders with uncontrolled asthma before the biologic still had incompletely controlled disease postbiologic initiation. Predictors of response were outcome-dependent. Lung function responders were more likely to have higher prebiologic FeNO (odds ratio = 1.20 for every 25-parts per billion increase), and shorter asthma duration (odds ratio = 0.81 for every 10-year increase in duration). Higher blood eosinophil count and the presence of type 2-related comorbidities were positively associated with higher odds of meeting long-term oral corticosteroid, control, and lung function responder criteria. CONCLUSIONS: Our findings underscore the multimodal nature of response, showing that many responders experience residual symptoms after biologic initiation and that predictors of response vary according to the outcome assessed.

Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

Dados da publicação

ISSN/ISSNe:
2213-2198, 2213-2201

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE  Elsevier

Tipo:
Article
Páginas:
2347-2361

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Keywords

  • Anti-IL4Ra; Anti-IL5/5R; Anti-IgE; Control; Exacerbation; Lung function; Oral corticosteroid

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