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Impact of Inititing Biologics in Patients With Severe Asthma on Long-term Oral Corticosteroids or Frequent Rescue Steroids (GLITTER): Data From the International Severe Asthma Registry

Chen, W. ; Bjermer, L. LU and Price, D.B. (2023) In Journal of Allergy and Clinical Immunology: In Practice 11(9). p.2732-2747
Abstract
Background: Effectiveness of biologics has neither been established in patients with high oral corticosteroid exposure (HOCS) nor been compared with effectiveness of continuing with HOCS alone. Objective: To examine the effectiveness of initiating biologics in a large, real-world cohort of adult patients with severe asthma and HOCS. Methods: This was a propensity score–matched, prospective cohort study using data from the International Severe Asthma Registry. Between January 2015 and February 2021, patients with severe asthma and HOCS (long-term OCSs for ≥1 year or ≥4 courses of rescue OCSs within a 12-month period) were identified. Biologic initiators were identified and, using propensity scores, matched 1:1 with noninitiators. The impact... (More)
Background: Effectiveness of biologics has neither been established in patients with high oral corticosteroid exposure (HOCS) nor been compared with effectiveness of continuing with HOCS alone. Objective: To examine the effectiveness of initiating biologics in a large, real-world cohort of adult patients with severe asthma and HOCS. Methods: This was a propensity score–matched, prospective cohort study using data from the International Severe Asthma Registry. Between January 2015 and February 2021, patients with severe asthma and HOCS (long-term OCSs for ≥1 year or ≥4 courses of rescue OCSs within a 12-month period) were identified. Biologic initiators were identified and, using propensity scores, matched 1:1 with noninitiators. The impact of biologic initiation on asthma outcomes was assessed using generalized linear models. Results: We identified 996 matched pairs of patients. Both groups improved over the 12-month follow-up period, but improvement was greater for biologic initiators. Biologic initiation was associated with a 72.9% reduction in the average number of exacerbations per year versus noninitiators (0.64 vs 2.06; rate ratio, 0.27 [95% CI, 0.10-0.71]). Biologic initiators were 2.2 times more likely than noninitiators to take a daily long-term OCS dose of less than 5 mg (risk probability, 49.6% vs 22.5%; P = .002) and had a lower risk of asthma-related emergency department visits (relative risk, 0.35 [95% CI, 0.21-0.58]; rate ratio, 0.26 [0.14-0.48]) and hospitalizations (relative risk, 0.31 [95% CI, 0.18-0.52]; rate ratio, 0.25 [0.13-0.48]). Conclusions: In a real-world setting, including patients with severe asthma and HOCS from 19 countries, and within an environment of clinical improvement, initiation of biologics was associated with further improvements across multiple asthma outcomes, including exacerbation rate, OCS exposure, and health care resource utilization. © 2023 The Authors (Less)
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keywords
Biologics, Effectiveness, ISAR, Oral corticosteroids, Real life, Adrenal Cortex Hormones, Adult, Anti-Asthmatic Agents, Asthma, Biological Products, Humans, Prospective Studies, Steroids, antiasthmatic agent, biological product, corticosteroid, steroid, adult, asthma, human, prospective study
in
Journal of Allergy and Clinical Immunology: In Practice
volume
11
issue
9
pages
16 pages
publisher
Elsevier
external identifiers
  • scopus:85164597997
  • pmid:37301430
ISSN
2213-2198
DOI
10.1016/j.jaip.2023.05.044
language
English
LU publication?
yes
id
c3c552dc-f505-418e-997f-0edbdb15518b
date added to LUP
2023-11-23 15:14:53
date last changed
2023-11-24 03:00:03
@article{c3c552dc-f505-418e-997f-0edbdb15518b,
  abstract     = {{Background: Effectiveness of biologics has neither been established in patients with high oral corticosteroid exposure (HOCS) nor been compared with effectiveness of continuing with HOCS alone. Objective: To examine the effectiveness of initiating biologics in a large, real-world cohort of adult patients with severe asthma and HOCS. Methods: This was a propensity score–matched, prospective cohort study using data from the International Severe Asthma Registry. Between January 2015 and February 2021, patients with severe asthma and HOCS (long-term OCSs for ≥1 year or ≥4 courses of rescue OCSs within a 12-month period) were identified. Biologic initiators were identified and, using propensity scores, matched 1:1 with noninitiators. The impact of biologic initiation on asthma outcomes was assessed using generalized linear models. Results: We identified 996 matched pairs of patients. Both groups improved over the 12-month follow-up period, but improvement was greater for biologic initiators. Biologic initiation was associated with a 72.9% reduction in the average number of exacerbations per year versus noninitiators (0.64 vs 2.06; rate ratio, 0.27 [95% CI, 0.10-0.71]). Biologic initiators were 2.2 times more likely than noninitiators to take a daily long-term OCS dose of less than 5 mg (risk probability, 49.6% vs 22.5%; P = .002) and had a lower risk of asthma-related emergency department visits (relative risk, 0.35 [95% CI, 0.21-0.58]; rate ratio, 0.26 [0.14-0.48]) and hospitalizations (relative risk, 0.31 [95% CI, 0.18-0.52]; rate ratio, 0.25 [0.13-0.48]). Conclusions: In a real-world setting, including patients with severe asthma and HOCS from 19 countries, and within an environment of clinical improvement, initiation of biologics was associated with further improvements across multiple asthma outcomes, including exacerbation rate, OCS exposure, and health care resource utilization. © 2023 The Authors}},
  author       = {{Chen, W. and Bjermer, L. and Price, D.B.}},
  issn         = {{2213-2198}},
  keywords     = {{Biologics; Effectiveness; ISAR; Oral corticosteroids; Real life; Adrenal Cortex Hormones; Adult; Anti-Asthmatic Agents; Asthma; Biological Products; Humans; Prospective Studies; Steroids; antiasthmatic agent; biological product; corticosteroid; steroid; adult; asthma; human; prospective study}},
  language     = {{eng}},
  number       = {{9}},
  pages        = {{2732--2747}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Allergy and Clinical Immunology: In Practice}},
  title        = {{Impact of Inititing Biologics in Patients With Severe Asthma on Long-term Oral Corticosteroids or Frequent Rescue Steroids (GLITTER): Data From the International Severe Asthma Registry}},
  url          = {{http://dx.doi.org/10.1016/j.jaip.2023.05.044}},
  doi          = {{10.1016/j.jaip.2023.05.044}},
  volume       = {{11}},
  year         = {{2023}},
}