1
|
Scelo G, Tran TN, Le TT, Faregås 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, Fonseca JA, 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. Exploring definitions and predictors of response to biologics for severe asthma. J Allergy Clin Immunol Pract 2024:S2213-2198(24)00530-0. [PMID: 38768896 DOI: 10.1016/j.jaip.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Biologic effectiveness is often assessed as 'response', a term which 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 4 asthma outcome domains were assessed in the 1-year period pre- and post-biologic-initiation in patients with predefined level of pre-biologic impairment. Responder cut-offs were: ≥50% reduction in exacerbation rate, ≥50% reduction in long-term oral corticosteroid [LTOCS] daily dose, ≥1 category improvement in asthma control, and ≥100mL improvement in FEV1. Responders were defined using single- and multiple-domains. The association between pre-biologic characteristics and post-biologic-initiation response were examined by multivariable analysis. RESULTS 2,210 patients were included. Responder rate ranged from 80.7% (n=566/701) for exacerbation-response to 10.6% (n=9/85) for 4-domain-response. Many responders still exhibited significant impairment post-biologic-initiation: 46.7% (n=206/441) of asthma control-responders with uncontrolled asthma pre-biologic still had incompletely-controlled disease post-biologic-initiation. Predictors of response were outcome-dependent. Lung function-responders were more likely to have higher pre-biologic FeNO (OR:1.20 for every 25ppb increase), and shorter asthma duration (OR:0.81, for every 10-year increase in duration). Higher BEC and presence of T2-related comorbidities were positively associated with higher odds of meeting LTOCS-, control- and lung function-responder criteria. CONCLUSION Our findings underscore the multi-modal nature of 'response', show that many responders experience residual symptoms post-biologic-initiation, and that predictors of response vary according to outcome assessed.
Collapse
Affiliation(s)
- Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, (Singapore); Optimum Patient Care Global, Cambridge (UK)
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca - Gaithersburg, MD (USA)
| | - Tham T Le
- BioPharmaceuticals Medical, AstraZeneca - Gaithersburg, MD (USA)
| | - Malin Faregås
- BioPharmaceuticals Medical, AstraZeneca - Gothenburg (Sweden); BioPharmaceuticals Medical, AstraZeneca - Gaithersburg, MD (USA)
| | - Delbert Dorscheid
- Center for Heart Lung Innovation, University of British Columbia, (Canada)
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University - Belfast (UK)
| | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University; Al-Rashed Allergy Center, Ministry of Health - Kuwait (Kuwait)
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City; Alfaisal University - Riyadh (Saudi Arabia); College of Medicine, Alfaisal University, Riyadh, (Saudi Arabia)
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, (Estonia)
| | | | - Celine Bergeron
- Centre for Lung Health, Vancouver General Hospital and University of British Columbia, Vancouver (Canada)
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, (Sweden)
| | - Anne S Bjerrum
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, (Denmark)
| | | | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano (Italy); Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan (Italy)
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, (Singapore); Optimum Patient Care Global, Cambridge (UK)
| | - Jeremy Charriot
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, (France)
| | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca (Spain)
| | - Eve Denton
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, (Australia); Department of Medicine, Central Clinical School, Monash University, (Australia)
| | - Maria Jose Fernandez-Sanchez
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogota, (Colombia); Faculty of Medicine, Pontificia Universidad Javeriana, Bogota (Colombia)
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto - Porto (Portugal)
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle; Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital - Newcastle (Australia)
| | - Celine Goh
- Observational and Pragmatic Research Institute, Singapore, (Singapore); Optimum Patient Care Global, Cambridge (UK)
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University - Belfast (UK)
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano (Italy); Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan (Italy)
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health; Public Health and Preventive Medicine, Monash University - Melbourne (Australia)
| | | | - Rohit Katial
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, (USA)
| | - Mariko S Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital - Singapore (Singapore)
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz - Lodz (Poland)
| | | | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, (Finland); Faculty of Medicine and Health Technology, Tampere University, Tampere, (Finland)
| | - Bassam Mahboub
- Rashid hospital, Dubai Health Authority (DHA) - Dubai (Utd.Arab Emir.)
| | - Neil Martin
- BioPharmaceuticals Medical, AstraZeneca - Cambridge (UK)
| | - Hisako Matsumoto
- Department of Respiratory Medicine & Allergology, Kindai University Faculty of Medicine, (Japan)
| | | | - Nikolaos G Papadopoulos
- Centre for Respiratory Medicine & Allergy, Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, (UK); Allergy and Clinical Immunology Unit, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens (Greece)
| | - Pujan Patel
- Respiratory Medicine, Royal Brompton Hospital, London, (UK)
| | - Luis Perez-De-Llano
- Pneumology Service. Lucus Augusti University Hospital. EOXI Lugo, Monforte, Cervo (Spain)
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney (Australia)
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London (UK)
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia (Bulgaria)
| | - Celeste M Porsbjerg
- Bispebjerg Hospital, Department of Respiratory Medicine and Infections Diseases, Research Unit - Copenhagen (Denmark)
| | - Chin K Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea - Seoul (South Korea)
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia - Vancouver (Canada)
| | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université Paris Cité, Paris, (France)
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana - Bogotá (Colombia)
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, (Taiwan); Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, (Taiwan)
| | - Charlotte S Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, (Denmark)
| | - John W Upham
- Frazer Institute & PA-Southside Clinical Unit, The University of Queensland, Brisbane, (Australia)
| | - Anna von Bülow
- Respiratory Research Unit - Hvidovre, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg hospital, Copenhagen, (Denmark)
| | - Eileen Wang
- National Jewish Health and University of Colorado School of Medicine - Denver and Aurora (USA)
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver (USA)
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, (Singapore); Optimum Patient Care Global, Cambridge (UK); Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen (UK).
| |
Collapse
|
2
|
Perez-de-Llano L, Scelo G, Tran TN, Le TT, Fagerås M, Cosio BG, Peters M, Pfeffer PE, Al-Ahmad M, Al-Lehebi RO, Altraja A, Bergeron C, Bjermer LH, Bjerrum AS, Bulathsinhala L, Busby J, Cano Rosales DJ, Canonica GW, Carter VA, Charriot J, Christoff GC, Denton EJ, Dorscheid DR, Fernandez Sanchez MJ, Fonseca JA, Gibson PG, Goh CYY, Heaney LG, Heffler E, Hew M, Iwanaga T, Katial R, Koh MS, Kuna P, Larenas-Linnemann DES, Lehtimäki L, Mahboub B, Martin N, Matsumoto H, Menzies-Gow AN, Papadopoulos NG, Popov TA, Porsbjerg CM, Patel P, Rhee CK, Sadatsafavi M, Taillé C, Torres-Duque CA, Tsai MJ, Ulrik CS, Upham JW, von Bülow A, Wang E, Wechsler ME, Price DB. Exploring Definitions and Predictors of Severe Asthma Clinical Remission Post-Biologic in Adults. Am J Respir Crit Care Med 2024. [PMID: 38701495 DOI: 10.1164/rccm.202311-2192oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/03/2024] [Indexed: 05/05/2024] Open
Abstract
RATIONALE There is no consensus on criteria to include in an asthma remission definition in real-life. Factors associated with achieving remission post-biologic-initiation remain poorly understood. OBJECTIVES To quantify the proportion of adults with severe asthma achieving multi-domain-defined remission post-biologic-initiation and identify pre-biologic characteristics associated with achieving remission which may be used to predict it. METHODS This was a longitudinal cohort study using data from 23 countries from the International Severe Asthma Registry. Four asthma outcome domains were assessed in the 1-year pre- and post-biologic-initiation. A priori-defined remission cut-offs were: 0 exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted forced expiratory volume in one second ≥80%. Remission was defined using 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. The association between pre-biologic characteristics and post-biologic remission was assessed by multivariable analysis. MEASUREMENTS AND MAIN RESULTS 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for 2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving 4-domain remission decreased by 15% for every additional 10-years asthma duration (odds ratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewer exacerbations/year, lower LTOCS daily dose, better control and better lung function pre-biologic-initiation. CONCLUSIONS One in 5 patients achieved 4-domain remission within 1-year of biologic-initiation. Patients with less severe impairment and shorter asthma duration at initiation had a greater chance of achieving remission post-biologic, indicating that biologic treatment should not be delayed if remission is the goal. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Collapse
Affiliation(s)
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, Singapore, Singapore
- Optimum Patient Care Global, Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Trung N Tran
- AstraZeneca, Gaithersburg, Maryland, United States
| | - Tham T Le
- AstraZeneca R&D Gaithersburg, 468090, Gaithersburg, Maryland, United States
| | | | - Borja G Cosio
- Hospital Universitari Son Espases, 375118, IdISBa and Respiratory Medicine, Palma de Mallorca, Spain
- Ciber Enfermedades Respiratorias (Ciberes), Madrid, Spain
| | - Matthew Peters
- Concord Hospital, Department of Thoracic Medicine, Sydney, Australia
| | - Paul E Pfeffer
- Queen Mary University of London, 4617, William Harvey Research Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Mona Al-Ahmad
- Kuwait University, Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, College of Medicine, Kuwait , Kuwait
| | - Riyad O Al-Lehebi
- King Fahad Medical City, 37849, Department of Pulmonology,, Riyadh, Saudi Arabia
- Alfaisal University, 101686, Riyadh, Saudi Arabia
| | - Alan Altraja
- University of Tartu and Lung Clinic, Tartu University Hospital, Department of Pulmonology, Tartu, Estonia
| | - Celine Bergeron
- Vancouver General Hospital, 8167, Vancouver, British Columbia, Canada
- The University of British Columbia, 8166, Vancouver, British Columbia, Canada
| | - Leif H Bjermer
- Skåne University Hospital Labmedicin Skane, 405121, Respiratory Medicine and Allergology, Lund, Skåne, Sweden
| | - Anne S Bjerrum
- Aarhus Universitetshospital, 11297, Department of Respiratory Medicine, Aarhus, Denmark
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute Pte Ltd, 614173, Singapore, Singapore
- Optimum Patient Care UK, 601419, Cambridge, England, United Kingdom of Great Britain and Northern Ireland
| | - John Busby
- Queen's University Belfast, Centre of Experimental Medicine, Belfast, United Kingdom of Great Britain and Northern Ireland
| | | | - Giorgio W Canonica
- IRCCS Humanitas Research Hospital, 9268, Personalized Medicine, Asthma and Allergy, Rozzano, Lombardia, Italy
- Humanitas University, 437807, Department of Biomedical Sciences, Milan, Italy
| | - Victoria A Carter
- Optimum Patient Care, Cambridge, United Kingdom of Great Britain and Northern Ireland
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Jeremy Charriot
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | | | | | | | - Maria J Fernandez Sanchez
- Hospital Universitario San Ignacio, 173049, Pulmonary Unit, Bogota, Colombia
- Pontificia Universidad Javeriana, 27964, Faculty of Medicine, Bogota, Colombia
| | - João A Fonseca
- Faculty of Medicine, University of Porto, CINTESIS, Porto, Portugal
- CUF Porto, Allergy Department, Senhora da Hora, Portugal
| | - Peter G Gibson
- University of Newcastle, 5982, Callaghan, New South Wales, Australia
| | - Celine Y Y Goh
- Observational and Pragmatic Research Institute Pte Ltd, 614173, Singapore, Singapore
| | - Liam G Heaney
- Belfast City Hospital, Regional Respiratory Centre, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Enrico Heffler
- Universita degli Studi di Catania, 9298, Clinical and Experimental Medicie, Catania, Italy
| | - Mark Hew
- Alfred Hospital, 5390, Allergy, Asthma & Clinical Immunology, Melbourne, Victoria, Australia
- Monash University Faculty of Medicine Nursing and Health Sciences, 22457, School of Public Health & Preventive Medicine, Melbourne, Victoria, Australia
| | - Takashi Iwanaga
- Kindai University Hospital, 326473, Osakasayama, Osaka, Japan
| | - Rohit Katial
- AstraZeneca US, 33366, BioPharmaceuticals Medical, Gaithersburg, Maryland, United States
| | - Mariko S Koh
- Singapore General Hospital, 37581, Department of Respiratory and Critical Care Medicine, Singapore, Singapore
| | - Piotr Kuna
- Medical University of Lodz, 37808, Division of Internal Medicine Asthma and Allergy, Lodz, Lodzkie, Poland
| | | | - Lauri Lehtimäki
- University of Tampere, 7840, Immunopharmacology reserach group, Tampere, Pirkanmaa, Finland
| | | | - Neil Martin
- AstraZeneca R&D Cambridge, 468087, Respiratory and Immunology, BioPharmaceuticals Medical, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland
- University of Leicester, 4488, Leicester, Leicestershire, United Kingdom of Great Britain and Northern Ireland
| | - Hisako Matsumoto
- Kindai University Faculty of Medicine, Department of Respiratory Medicine & Allergology, Osakasayama, Osaka, Japan
| | - Andrew N Menzies-Gow
- AstraZeneca UK Limited, 4978, Cambridge, United Kingdom of Great Britain and Northern Ireland
- Royal Brompton and Harefield Hospitals, 4964, London, United Kingdom of Great Britain and Northern Ireland
| | - Nikolaos G Papadopoulos
- University of Athens, Allergy Dpt, 2nd Pediatric Clinic, Athens, Greece
- University of Manchester, Centre for Paediatrics and Child Health, Institute of Human Development, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Todor A Popov
- Medical University Sofia, Clinic of Allergy & Asthma, Sofia, Bulgaria
| | - Celeste M Porsbjerg
- Bispebjerg Hospital, 53166, Department of Respiratory Medicine, Copenhagen NV, Denmark
- University of Copenhagen, 4321, Institute of Clinical Medicine, Kobenhavn, Denmark
| | - Pujan Patel
- Royal Brompton Hospital, 156726, London, United Kingdom of Great Britain and Northern Ireland
| | - Chin K Rhee
- Catholic university of Korea, Internal medicine, Seoul, Korea (the Republic of)
| | - Mohsen Sadatsafavi
- University of British Columbia, Institute for Heart and Lung Health, Vancouver, British Columbia, Canada
| | - Camille Taillé
- Inserm, Pathophysiology and Epidemiology of respiratory diseases. Epidemiology team, Paris, France
- Assistance Publique-Hôpitaux de Paris,, Paris, France
| | - Carlos A Torres-Duque
- Fundación Neumológica Colombiana, Research Department, Bogotá, Colombia
- Universidad de La Sabana, 27989, Chia, Colombia
| | - Ming-Ju Tsai
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung, Taiwan
| | - Charlotte S Ulrik
- Hvidovre Hospital, 53137, Respiratory Medicine, Hvidovre, Denmark
- University of Copenhagen, Institute of Clinical Medicine, Denmark
| | - John W Upham
- The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Anna von Bülow
- Copenhagen University Hospital Bispebjerg, Department of Respiratory Medicine, Copenhagen, Denmark
| | - Eileen Wang
- National Jewish Health, 2930, Division of Allergy and Clinical Immunology, Department of Medicine, Denver, Colorado, United States
| | - Michael E Wechsler
- National Jewish Health, Department of Medicine, Denver, Colorado, United States
| | - David B Price
- University of Aberdeen, Academic Primary Care, Aberdeen, Scotland, United Kingdom of Great Britain and Northern Ireland;
| |
Collapse
|