AI Article Synopsis

  • Previous studies on how comorbidities affect the effectiveness of biologic agents in asthma were limited in size and duration, lacking comparisons between different biologic classes.
  • This cohort study analyzed data from the International Severe Asthma Registry across 21 countries to assess changes in asthma outcomes after starting biologic therapy in patients with type 2-related comorbidities.
  • Results showed that patients with chronic rhinosinusitis (CRS) and nasal polyps (NPs) experienced significantly better outcomes, including fewer exacerbations and improved asthma control, while allergic rhinitis and atopic dermatitis did not influence therapy effectiveness.

Article Abstract

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. To determine the association between type 2-related comorbidities and biologic agent effectiveness in adults with severe asthma (SA). 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, FEV% 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. 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%;  < 0.001) and had 59% higher odds of better post-biologic therapy asthma control (95% CI, 26-102%;  < 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 FEV% predicted improvement of 3.2% (95% CI, 1.0-5.3;  = 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. 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.

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Source
http://dx.doi.org/10.1164/rccm.202305-0808OCDOI Listing

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