Association Between T2-related Comorbidities and Effectiveness of Biologics in Severe Asthma
Michael E. Wechsler, Ghislaine Scélo, Désirée Larenas‐Linnemann, Carlos A. Torres‐Duque, Jorge Máspero, Trung N. Tran, Ruth Murray, Neil Martin, Andrew Menzies‐Gow, Mark Hew, Matthew Peters, Peter G. Gibson, George Christoff, Todor A. Popov, Andréanne Côté, Céline Bergeron, Delbert R. Dorscheid, J Mark FitzGerald, Kenneth R. Chapman, Louis Philippe Boulet, Mohit Bhutani, Mohsen Sadatsafavi, Libardo Jiménez-Maldonado, Mauricio Durán-Silva, Bellanid Rodriguez, C.A. Celis-Preciado, Diana Jimena Cano-Rosales, Iván Solarte, Maria Jose Fernandez-Sanchez, Patricia Parada-Tovar, Anna von Bülow, Anne Sofie Bjerrum, Charlotte Suppli Ulrik, Karin Dahl Assing, Linda Makowska Rasmussen, Susanne Hansen, Alan Altraja, Arnaud Bourdin, Camille Taillé, Jérémy Charriot, Nicolás Roche, Andriana Ι. Papaioannou, Κonstantinos Κostikas, Nikolaos G. Papadopoulos, Sundeep Salvi, Deirdre Long, Patrick Mitchell, Richard W. Costello, Concetta Sirena, Cristina Cardini, Enrico Heffler, Francesca Puggioni, Giorgio Walter Canonica, Giuseppe Guida, Takashi Iwanaga, Mona Al‐Ahmad, Ulises García, Piotr Kuna, João Fonseca, Riyad Al‐Lehebi, Mariko Siyue Koh, Chin Kook Rhee, Borja G. Cosío, Luís Pérez de Llano, Diahn-Warng Perng, Erick Wan-Chun Huang, Hao‐Chien Wang, Ming‐Ju Tsai, Bassam Mahboub, Laila Salameh, D.J. Jackson, John Busby, Liam G. Heaney, Paul Pfeffer, Amanda Grippen Goddard, Eileen Wang, Flavia Hoyte, Nicholas Chapman, Rohit Katial, Victoria Carter, Lakmini Bulathsinhala, Neva Eleangovan, Con Ariti, Juntao Lyu, Celeste Porsbjerg, David Price
Abstract
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.