Comparative effectiveness of <scp>anti‐IL5</scp> and <scp>anti‐IgE</scp> biologic classes in patients with severe asthma eligible for both
Paul Pfeffer, Nasloon Ali, Ruth Murray, Charlotte Suppli Ulrik, Trung N. Tran, Jorge Máspero, Matthew Peters, George Christoff, Mohsen Sadatsafavi, Carlos A. Torres‐Duque, Alan Altraja, Lauri Lehtimäki, Nikolaos G. Papadopoulos, Sundeep Salvi, Richard W. Costello, Breda Cushen, Enrico Heffler, Takashi Iwanaga, Mona Al‐Ahmad, Désirée Larenas‐Linnemann, Piotr Kuna, João Fonseca, Riyad Al‐Lehebi, Chin Kook Rhee, Luis Pérez de Llano, Diahn‐Warng Perng Steve, Bassam Mahboub, Eileen Wang, Celine Goh, Juntao Lyu, A Newell, Marianna Alacqua, А. S. Belevskiy, Mohit Bhutani, Leif Bjermer, Unnur Steina Björnsdóttir, Arnaud Bourdin, Anna von Bülow, John Busby, Giorgio Walter Canonica, Borja G. Cosío, Delbert R. Dorscheid, Mariana Muñoz‐Esquerre, J. Mark FitzGerald, Esther García Gil, Peter G. Gibson, Liam G. Heaney, Mark Hew, Ole Hilberg, Flavia Hoyte, David J. Jackson, Mariko Siyue Koh, Hsin‐Kuo Ko, Jae Ha Lee, Sverre Lehmann, Cláudia Chaves Loureiro, Dóra Lúðvíksdóttir, Andrew N. Menzies‐Gow, Patrick Mitchell, Andriana Ι. Papaioannou, Todor A. Popov, Celeste Porsbjerg, Laila Salameh, Concetta Sirena, Camille Taillé, Christian Taube, Yuji Tohda, Michael E. Wechsler, David Price
Abstract
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.