Real World Biologic Use and Switch Patterns in Severe Asthma: Data from the International Severe Asthma Registry and the US CHRONICLE Study

Andrew N Menzies-Gow; Claire McBrien; Bindhu Unni; Celeste M Porsbjerg; Mona Al-Ahmad; Christopher S Ambrose; Karin Dahl Assing; Anna von Bülow; John Busby; Borja G Cosio; J Mark FitzGerald; Esther Garcia Gil; Susanne Hansen; Liam G aHeaney; Mark Hew; David J Jackson; Maria Kallieri; Stelios Loukides; Njira L Lugogo; Andriana I Papaioannou; Désirée Larenas-Linnemann; Wendy C Moore; Luis A Perez-de-Llano; Linda M Rasmussen; Johannes M Schmid; Salman Siddiqui; Marianna Alacqua; Trung N Tran; Charlotte Suppli Ulrik; John W Upham; Eileen Wang; Lakmini Bulathsinhala; Victoria A Carter; Isha Chaudhry; Neva Eleangovan; Ruth B Murray; Chris A Price; David B Price

doi:10.2147/JAA.S328653

Real World Biologic Use and Switch Patterns in Severe Asthma: Data from the International Severe Asthma Registry and the US CHRONICLE Study

J Asthma Allergy. 2022 Jan 13:15:63-78. doi: 10.2147/JAA.S328653. eCollection 2022.

Authors

Andrew N Menzies-Gow¹, Claire McBrien², Bindhu Unni³, Celeste M Porsbjerg⁴, Mona Al-Ahmad⁵, Christopher S Ambrose⁶, Karin Dahl Assing⁷, Anna von Bülow⁴, John Busby⁸, Borja G Cosio⁹, J Mark FitzGerald¹⁰, Esther Garcia Gil¹¹, Susanne Hansen¹², Liam G aHeaney⁸, Mark Hew^{13

14}, David J Jackson^{15

16}, Maria Kallieri¹⁷, Stelios Loukides¹⁷, Njira L Lugogo¹⁸, Andriana I Papaioannou¹⁷, Désirée Larenas-Linnemann¹⁹, Wendy C Moore²⁰, Luis A Perez-de-Llano²¹, Linda M Rasmussen²², Johannes M Schmid²³, Salman Siddiqui²⁴, Marianna Alacqua²⁵, Trung N Tran⁶, Charlotte Suppli Ulrik²⁶, John W Upham²⁷, Eileen Wang^{28

29}, Lakmini Bulathsinhala^{3

30}, Victoria A Carter^{3

30}, Isha Chaudhry^{3

30}, Neva Eleangovan^{3

30}, Ruth B Murray^{3

30}, Chris A Price^{3

30}, David B Price^{3

30

31}

Affiliations

¹ UK Severe Asthma Network and National Registry, Royal Brompton & Harefield Hospitals, London, UK.
² Kingston Hospital, London, UK.
³ Observational and Pragmatic Research Institute, Singapore, Singapore.
⁴ Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.
⁵ Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait, Kuwait.
⁶ AstraZeneca, Gaithersburg, MD, USA.
⁷ Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark.
⁸ UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland.
⁹ Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain.
¹⁰ The Centre for Lung Health, Vancouver Coastal Health Research Institute, UBC, Vancouver, Canada.
¹¹ AstraZeneca, Barcelona, Spain.
¹² Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
¹³ Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia.
¹⁴ Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹⁵ UK Severe Asthma Network andNational Registry, Guy's and St Thomas' NHS Trust, London, UK.
¹⁶ School of Immunology & Microbial Sciences, King's College London, London, UK.
¹⁷ 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece.
¹⁸ Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.
¹⁹ Directora Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Ciudad de México, Mexico.
²⁰ Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
²¹ Department of Respiratory Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain.
²² Allergy Clinic, Department of Dermato-Allergology, Gentofte Hospital, Copenhagen, Denmark.
²³ University Hospital of Aarhus, Aarhus, Denmark.
²⁴ University of Leicester, Department of Respiratory Sciences & NIHR Leicester Biomedical Research Centre (Respiratory Theme), Leicester, UK.
²⁵ AstraZeneca, Cambridge, UK.
²⁶ Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.
²⁷ Diamantina Institute & PA-Southside Clinical Unit, The University of Queensland, Brisbane, Australia.
²⁸ Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, USA.
²⁹ Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
³⁰ Optimum Patient Care, Cambridge, UK.
³¹ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.

Abstract

Introduction: International registries provide opportunities to describe use of biologics for treating severe asthma in current clinical practice. Our aims were to describe real-life global patterns of biologic use (continuation, switches, and discontinuations) for severe asthma, elucidate reasons underlying these patterns, and examine associated patient-level factors.

Methods: This was a historical cohort study including adults with severe asthma enrolled into the International Severe Asthma Registry (ISAR; http://isaregistries.org, 2015-2020) or the CHRONICLE Study (2018-2020) and treated with a biologic. Eleven countries were included (Bulgaria, Canada, Denmark, Greece, Italy, Japan, Kuwait, South Korea, Spain, UK, and USA). Biologic utilization patterns were defined: 1) continuing initial biologic; 2) stopping biologic treatment; or 3) switching to another biologic. Reasons for discontinuation/switching were recorded and comparisons drawn between groups.

Results: A total of 3531 patients were included. Omalizumab was the most common initial biologic in 2015 (88.2%) and benralizumab in 2019 (29.6%). Most patients (79%; 2791/3531) continued their first biologic; 10.2% (356/3531) stopped; 10.8% (384/3531) switched. The most frequent first switch was from omalizumab to an anti-IL-5/5R (49.6%; 187/377). The most common subsequent switch was from one anti-IL-5/5R to another (44.4%; 20/45). Insufficient efficacy and/or adverse effects were the most frequent reasons for stopping/switching. Patients who stopped/switched were more likely to have a higher baseline blood eosinophil count and exacerbation rate, lower lung function, and greater health care resource utilization.

Conclusion: The description of real-life patterns of continuing, stopping, or switching biologics enhances our understanding of global biologic use. Prospective studies involving structured switching criteria could ascertain optimal strategies to identify patients who may benefit from switching.

Keywords: biologics; cohort study; international; management; prescribing; severe asthma.

Grants and funding

This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by the Observational & Pragmatic Research Institute Pte Ltd (OPRI) for its contribution.