Impact of Biologics Initiation on Oral Corticosteroid Use in the International Severe Asthma Registry and the Optimum Patient Care Research Database: A Pooled Analysis of Real-World Data
Wenjia Chen, Trung N. Tran, John Townend, George Christoff, Ming-Ju Tsai, Alan Altraja, Belinda Cochrane, Borja G. Cosío, Martín Sívori, Ruth Murray, Μichael Μakris, Ghislaine Scélo, Lakmini Bulathsinhala, Ledit Ardusso, María Eugenia Franchi, Jorge Máspero, Fernando Saldarini, Ana María Stok, Ana Giselle Tomaszuk, Anahí Yañez, Benjamin Emmanuel, Cathy Emmas, Κonstantinos Κostikas, Andrew Menzies‐Gow, Neda Stjepanovic, Sinthia Bosnic‐Anticevich, Eve Denton, Peter G. Gibson, Mark Hew, Christine Jenkins, Peter G. Middleton, Matthew Peters, John W. Upham, Guy Brusselle, Renaud Louis, Florence Schleich, Paulo Márcio Pitrez, Todor A. Popov, Céline Bergeron, Mohit Bhutani, Kenneth R. Chapman, Andréanne Côté, Simon Couillard, Delbert R. Dorscheid, M. Diane Lougheed, Mohsen Sadatsafavi, Carlos Andrés Celis-Preciado, Libardo Jiménez-Maldonado, Bellanid Rodríguez-Cáceres, Diana Jimena Cano Rosales, Iván Solarte, Carlos A. Torres‐Duque, Susanne Hansen, Celeste Porsbjerg, Charlotte Suppli Ulrik, Arnaud Bourdin, Petros Bakakos, Konstantinos Exarchos, Athena Gogali, Aggelos Ladias, Nikolaos G. Papadopoulos, Andriana Ι. Papaioannou, Richard W. Costello, Breda Cushen, Patrick Mitchell, Giorgio Walter Canonica, Enrico Heffler, Francesca Puggioni, Takashi Iwanaga, Tatsuya Nagano, Yuji Tohda, Mona Al‐Ahmad, Désirée Larenas‐Linnemann, Bernt Bøgvald Aarli, Sverre Lehmann, Piotr Kuna, José Alberto Ferreira, João Fonseca, Cláudia Chaves Loureiro, Riyad Al‐Lehebi, Adeeb A. Bulkhi, Yah Ru Juang, Mariko Siyue Koh, Anqi Liu, Chin Kook Rhee, Luis Pérez de Llano, Pin‐Kuei Fu, Diahn‐Warng Perng, Chau‐Chyun Sheu, Hao‐Chien Wang, Bassam Mahboub, Laila Salameh, John Busby, Liam G. Heaney, David J. Jackson, Pujan H. Patel, Paul Pfeffer, Flavia Hoyte, Rohit Katial, Njira Lugogo
Abstract
BACKGROUND: For severe asthma (SA) management, real-world evidence on the effects of biologic therapies in reducing the burden of oral corticosteroid (OCS) use is limited. OBJECTIVE: To estimate the efficacy of biologic initiation on total OCS (TOCS) exposure in patients with SA from real-world specialist and primary care settings. METHODS: From the International Severe Asthma Registry (ISAR, specialist care) and the Optimum Patient Care Research Database (OPCRD, primary care, United Kingdom), adult biologic initiators were identified and propensity score-matched with non-initiators (ISAR, 1:1; OPCRD, 1:2). The impact of biologic initiation on TOCS (including bursts for exacerbations) daily dose in the first- and second-year follow-up period was estimated using multivariable generalized linear models. RESULTS: Among 5,663 patients (ISAR 48%, OPCRD 52%), the odds ratios (ORs) of biologic initiators achieving TOCS cessation in the first and second years of follow-up were 2.38 (95% CI, 1.87-3.04) and 2.11 (95% CI, 1.65-2.70), whereas the ORs of low (0- to 5-mg) TOCS intake were 1.62 (95% CI, 1.40-1.86) and 1.40 (95% CI, 1.21-1.61), respectively. Compared with non-initiators, biologic initiators had a substantially higher chance of achieving greater than 75% reduction from baseline (OR [95% CI] = 2.35 [2.06-2.68] and 1.53 [1.35-1.73] in first and second years, respectively). These findings remained persistent and robust when analyses were repeated with one country setting removed at a time. CONCLUSIONS: Biologic initiation in patients with SA led to substantial reduction in TOCS exposure, particularly in the first year. Future analyses will explore the impact on OCS-related adverse health events.