A retrospective cohort study in severe asthma describing commonly measured biomarkers

Eosinophil count and IgE levels

John Haughney*, Alyn Morice, Kevin G. Blyth, Amanda J. Lee, Alasdair Coutts, Eddie McKnight, Ian Pavord

*Corresponding author for this work

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Identifying asthma patients suitable for biologic therapy includes the assessment of blood biomarkers (IgE and eosinophils (EOS)). How they relate to each other is unclear. Methods This retrospective, database study used routinely collected clinical data to identify and evaluate an asthma cohort (classification code for asthma; ≥ 18 years; ≥1 prescription for asthma; ≥1 estimation of serum IgE, in 2 years prior to index date). Distribution into high and low IgE and EOS groups (IgE cut-point: > or ≤75 kU/L; EOS cut point: >or ≤400 μ/L), and characteristics by group are described. Findings In patients with severe asthma (British Thoracic Society Step (BTS) ≥4; N = 884), using maximum recorded IgE/EOS, 33% had high IgE/high EOS, 28% low IgE/low EOS and approximately a fifth each had high IgE/low EOS or low IgE/high EOS. Proportions were similar when EOS values measured 2 or 4 weeks before an exacerbation were excluded. Using EOS/IgE ′same day’ measurements (N = 578) only identified half of the high EOS group. Patients in high IgE groups were more likely to be younger males without comorbid COPD; those in high EOS groups were more likely to be on BTS treatment Step 5 vs 4. The low IgE/low EOS group had the lowest incidence of asthma-related hospital attendances, the highest incidence was observed in the high EOS groups. Conclusion Maximum available EOS measurement irrespective of exacerbations may be relevant when considering therapy. These data showed low IgE/Low EOS to be more benign and high EOS groups at increased risk of frequent, severe exacerbations.

Original languageEnglish
Pages (from-to)117-123
Number of pages7
JournalRespiratory Medicine
Volume134
Early online date5 Dec 2017
DOIs
Publication statusPublished - 1 Jan 2018

Fingerprint

Eosinophils
Immunoglobulin E
Cohort Studies
Asthma
Retrospective Studies
Biomarkers
Biological Therapy
Incidence
Chronic Obstructive Pulmonary Disease
Prescriptions

Keywords

  • Biologic therapy
  • Eosinophils
  • IgE
  • Severe asthma

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

A retrospective cohort study in severe asthma describing commonly measured biomarkers : Eosinophil count and IgE levels. / Haughney, John; Morice, Alyn; Blyth, Kevin G.; Lee, Amanda J.; Coutts, Alasdair; McKnight, Eddie; Pavord, Ian.

In: Respiratory Medicine, Vol. 134, 01.01.2018, p. 117-123.

Research output: Contribution to journalArticle

Haughney, John ; Morice, Alyn ; Blyth, Kevin G. ; Lee, Amanda J. ; Coutts, Alasdair ; McKnight, Eddie ; Pavord, Ian. / A retrospective cohort study in severe asthma describing commonly measured biomarkers : Eosinophil count and IgE levels. In: Respiratory Medicine. 2018 ; Vol. 134. pp. 117-123.
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title = "A retrospective cohort study in severe asthma describing commonly measured biomarkers: Eosinophil count and IgE levels",
abstract = "Background Identifying asthma patients suitable for biologic therapy includes the assessment of blood biomarkers (IgE and eosinophils (EOS)). How they relate to each other is unclear. Methods This retrospective, database study used routinely collected clinical data to identify and evaluate an asthma cohort (classification code for asthma; ≥ 18 years; ≥1 prescription for asthma; ≥1 estimation of serum IgE, in 2 years prior to index date). Distribution into high and low IgE and EOS groups (IgE cut-point: > or ≤75 kU/L; EOS cut point: >or ≤400 μ/L), and characteristics by group are described. Findings In patients with severe asthma (British Thoracic Society Step (BTS) ≥4; N = 884), using maximum recorded IgE/EOS, 33{\%} had high IgE/high EOS, 28{\%} low IgE/low EOS and approximately a fifth each had high IgE/low EOS or low IgE/high EOS. Proportions were similar when EOS values measured 2 or 4 weeks before an exacerbation were excluded. Using EOS/IgE ′same day’ measurements (N = 578) only identified half of the high EOS group. Patients in high IgE groups were more likely to be younger males without comorbid COPD; those in high EOS groups were more likely to be on BTS treatment Step 5 vs 4. The low IgE/low EOS group had the lowest incidence of asthma-related hospital attendances, the highest incidence was observed in the high EOS groups. Conclusion Maximum available EOS measurement irrespective of exacerbations may be relevant when considering therapy. These data showed low IgE/Low EOS to be more benign and high EOS groups at increased risk of frequent, severe exacerbations.",
keywords = "Biologic therapy, Eosinophils, IgE, Severe asthma",
author = "John Haughney and Alyn Morice and Blyth, {Kevin G.} and Lee, {Amanda J.} and Alasdair Coutts and Eddie McKnight and Ian Pavord",
note = "Acknowledgements: The authors acknowledge editorial support in the form of assistance in the development of manuscript drafts, collating author comments and copyediting, which was provided by Kate Hollingworth of Continuous Improvement Ltd. This support was funded by NSHI.",
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AU - Haughney, John

AU - Morice, Alyn

AU - Blyth, Kevin G.

AU - Lee, Amanda J.

AU - Coutts, Alasdair

AU - McKnight, Eddie

AU - Pavord, Ian

N1 - Acknowledgements: The authors acknowledge editorial support in the form of assistance in the development of manuscript drafts, collating author comments and copyediting, which was provided by Kate Hollingworth of Continuous Improvement Ltd. This support was funded by NSHI.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background Identifying asthma patients suitable for biologic therapy includes the assessment of blood biomarkers (IgE and eosinophils (EOS)). How they relate to each other is unclear. Methods This retrospective, database study used routinely collected clinical data to identify and evaluate an asthma cohort (classification code for asthma; ≥ 18 years; ≥1 prescription for asthma; ≥1 estimation of serum IgE, in 2 years prior to index date). Distribution into high and low IgE and EOS groups (IgE cut-point: > or ≤75 kU/L; EOS cut point: >or ≤400 μ/L), and characteristics by group are described. Findings In patients with severe asthma (British Thoracic Society Step (BTS) ≥4; N = 884), using maximum recorded IgE/EOS, 33% had high IgE/high EOS, 28% low IgE/low EOS and approximately a fifth each had high IgE/low EOS or low IgE/high EOS. Proportions were similar when EOS values measured 2 or 4 weeks before an exacerbation were excluded. Using EOS/IgE ′same day’ measurements (N = 578) only identified half of the high EOS group. Patients in high IgE groups were more likely to be younger males without comorbid COPD; those in high EOS groups were more likely to be on BTS treatment Step 5 vs 4. The low IgE/low EOS group had the lowest incidence of asthma-related hospital attendances, the highest incidence was observed in the high EOS groups. Conclusion Maximum available EOS measurement irrespective of exacerbations may be relevant when considering therapy. These data showed low IgE/Low EOS to be more benign and high EOS groups at increased risk of frequent, severe exacerbations.

AB - Background Identifying asthma patients suitable for biologic therapy includes the assessment of blood biomarkers (IgE and eosinophils (EOS)). How they relate to each other is unclear. Methods This retrospective, database study used routinely collected clinical data to identify and evaluate an asthma cohort (classification code for asthma; ≥ 18 years; ≥1 prescription for asthma; ≥1 estimation of serum IgE, in 2 years prior to index date). Distribution into high and low IgE and EOS groups (IgE cut-point: > or ≤75 kU/L; EOS cut point: >or ≤400 μ/L), and characteristics by group are described. Findings In patients with severe asthma (British Thoracic Society Step (BTS) ≥4; N = 884), using maximum recorded IgE/EOS, 33% had high IgE/high EOS, 28% low IgE/low EOS and approximately a fifth each had high IgE/low EOS or low IgE/high EOS. Proportions were similar when EOS values measured 2 or 4 weeks before an exacerbation were excluded. Using EOS/IgE ′same day’ measurements (N = 578) only identified half of the high EOS group. Patients in high IgE groups were more likely to be younger males without comorbid COPD; those in high EOS groups were more likely to be on BTS treatment Step 5 vs 4. The low IgE/low EOS group had the lowest incidence of asthma-related hospital attendances, the highest incidence was observed in the high EOS groups. Conclusion Maximum available EOS measurement irrespective of exacerbations may be relevant when considering therapy. These data showed low IgE/Low EOS to be more benign and high EOS groups at increased risk of frequent, severe exacerbations.

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