Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in severe asthma patients eligible for both

David Price; paul pfeffer; Nasloon Ali; Ruth Murray; Charlotte Ulrik; Trung Tran; Jorge Maspero; Matthew Peters; George Christoff; Mohsen Sadatsafavi; Carlos A. Torres-Duque; Alan Altraja; Lauri Lehtimäki; Nikolaos Papadopoulos; Sundeep Salvi; Richard W. Costello; Breda Cushen; Enrico Heffler; Takashi Iwanaga; Mona Al-Ahmad; Désirée Larenas-Linnemann; Piotr Kuna; João Fonseca; Riyad Al-Lehebi; Chin Kook Rhee; Luis Perez de Llano; Diahn-Wang Perng; Bassam Mahboub; Eileen Wang; Yun Yi Celine Goh; Juntao Lyu; Anthony Newell; Marianna Alacqua; Mohit Bhutani; Leif Bjermer; Unnur Steina Björnsdóttir; Arnaud Bourdin; Anna Von Bülow; John Busby; Walter Canonica; Borja G Cosio; Delbert Dorscheid; Mariana Muñoz Esquerre; Mark FitzGerald; Esther Garcia Gil; Peter Gerard Gibson; Liam Heaney; Mark Hew; Ole Hilberg; Flavia Hoyte; David Jackson; Mariko Koh; Hsin-Kuo Ko; Jae Ha Lee; Sverre Lehmann; Claudia Chaves Loureiro; Dora Ludviksdottir; Andrew Menzies-Gow; Patrick Mitchell; Andriana Papaioannou; Todor Popov; Celeste Porsbjerg; Laila Salameh; Concetta Sirena; Camille Taillé; Christian Taube; Yuji Tohda; M. E. Wechsler

doi:10.22541/au.166563547.79282253/v1

Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in severe asthma patients eligible for both

David Price^* (Corresponding Author), paul pfeffer, Nasloon Ali, Ruth Murray, Charlotte Ulrik, Trung Tran, Jorge Maspero, Matthew Peters, George Christoff, Mohsen Sadatsafavi, Carlos A. Torres-Duque, Alan Altraja, Lauri Lehtimäki, Nikolaos Papadopoulos, Sundeep Salvi, Richard W. Costello, Breda Cushen, Enrico Heffler, Takashi Iwanaga, Mona Al-AhmadDésirée Larenas-Linnemann, Piotr Kuna, João Fonseca, Riyad Al-Lehebi, Chin Kook Rhee, Luis Perez de Llano, Diahn-Wang Perng, Bassam Mahboub, Eileen Wang, Yun Yi Celine Goh, Juntao Lyu, Anthony Newell, Marianna Alacqua, Mohit Bhutani, Leif Bjermer, Unnur Steina Björnsdóttir, Arnaud Bourdin, Anna Von Bülow, John Busby, Walter Canonica, Borja G Cosio, Delbert Dorscheid, Mariana Muñoz Esquerre, Mark FitzGerald, Esther Garcia Gil, Peter Gerard Gibson, Liam Heaney, Mark Hew, Ole Hilberg, Flavia Hoyte, David Jackson, Mariko Koh, Hsin-Kuo Ko, Jae Ha Lee, Sverre Lehmann, Claudia Chaves Loureiro, Dora Ludviksdottir, Andrew Menzies-Gow, Patrick Mitchell, Andriana Papaioannou, Todor Popov, Celeste Porsbjerg, Laila Salameh, Concetta Sirena, Camille Taillé, Christian Taube, Yuji Tohda, M. E. Wechsler

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background
Patients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life.
Methods
This was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term366 oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance and hospital admissions.
Results
In the matched analysis (n=350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p372 experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs 20.55% reduction; p=0.023).) There was some evidence to suggest that patients treated with anti374 IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43).
Conclusions
In real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes, however anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use.

Original language	English
Journal	Allergy
DOIs	https://doi.org/10.22541/au.166563547.79282253/v1
Publication status	Accepted/In press - 23 Dec 2022

Keywords

biologics
exacerbation
ISAR
real life
oral corticosteroids

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Price, D., pfeffer, P., Ali, N., Murray, R., Ulrik, C., Tran, T., Maspero, J., Peters, M., Christoff, G., Sadatsafavi, M., Torres-Duque, C. A., Altraja, A., Lehtimäki, L., Papadopoulos, N., Salvi, S., Costello, R. W., Cushen, B., Heffler, E., Iwanaga, T., ... Wechsler, M. E. (Accepted/In press). Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in severe asthma patients eligible for both. Allergy. https://doi.org/10.22541/au.166563547.79282253/v1

Price, D, pfeffer, P, Ali, N, Murray, R, Ulrik, C, Tran, T, Maspero, J, Peters, M, Christoff, G, Sadatsafavi, M, Torres-Duque, CA, Altraja, A, Lehtimäki, L, Papadopoulos, N, Salvi, S, Costello, RW, Cushen, B, Heffler, E, Iwanaga, T, Al-Ahmad, M, Larenas-Linnemann, D, Kuna, P, Fonseca, J, Al-Lehebi, R, Rhee, CK, Llano, LPD, Perng, D-W, Mahboub, B, Wang, E, Goh, YYC, Lyu, J, Newell, A, Alacqua, M, Bhutani, M, Bjermer, L, Björnsdóttir, US, Bourdin, A, Bülow, AV, Busby, J, Canonica, W, Cosio, BG, Dorscheid, D, Esquerre, MM, FitzGerald, M, Gil, EG, Gibson, PG, Heaney, L, Hew, M, Hilberg, O, Hoyte, F, Jackson, D, Koh, M, Ko, H-K, Lee, JH, Lehmann, S, Loureiro, CC, Ludviksdottir, D, Menzies-Gow, A, Mitchell, P, Papaioannou, A, Popov, T, Porsbjerg, C, Salameh, L, Sirena, C, Taillé, C, Taube, C, Tohda, Y & Wechsler, ME 2022, 'Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in severe asthma patients eligible for both', Allergy. https://doi.org/10.22541/au.166563547.79282253/v1

@article{f4811cc9781f4b28810c7c88061e00df,

title = "Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in severe asthma patients eligible for both",

abstract = "BackgroundPatients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life.MethodsThis was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term366 oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance and hospital admissions.ResultsIn the matched analysis (n=350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p372 experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs 20.55% reduction; p=0.023).) There was some evidence to suggest that patients treated with anti374 IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43).ConclusionsIn real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes, however anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use.",

keywords = "biologics, exacerbation, ISAR, real life, oral corticosteroids",

author = "David Price and paul pfeffer and Nasloon Ali and Ruth Murray and Charlotte Ulrik and Trung Tran and Jorge Maspero and Matthew Peters and George Christoff and Mohsen Sadatsafavi and Torres-Duque, {Carlos A.} and Alan Altraja and Lauri Lehtim{\"a}ki and Nikolaos Papadopoulos and Sundeep Salvi and Costello, {Richard W.} and Breda Cushen and Enrico Heffler and Takashi Iwanaga and Mona Al-Ahmad and D{\'e}sir{\'e}e Larenas-Linnemann and Piotr Kuna and Jo{\~a}o Fonseca and Riyad Al-Lehebi and Rhee, {Chin Kook} and Llano, {Luis Perez de} and Diahn-Wang Perng and Bassam Mahboub and Eileen Wang and Goh, {Yun Yi Celine} and Juntao Lyu and Anthony Newell and Marianna Alacqua and Mohit Bhutani and Leif Bjermer and Bj{\"o}rnsd{\'o}ttir, {Unnur Steina} and Arnaud Bourdin and B{\"u}low, {Anna Von} and John Busby and Walter Canonica and Cosio, {Borja G} and Delbert Dorscheid and Esquerre, {Mariana Mu{\~n}oz} and Mark FitzGerald and Gil, {Esther Garcia} and Gibson, {Peter Gerard} and Liam Heaney and Mark Hew and Ole Hilberg and Flavia Hoyte and David Jackson and Mariko Koh and Hsin-Kuo Ko and Lee, {Jae Ha} and Sverre Lehmann and Loureiro, {Claudia Chaves} and Dora Ludviksdottir and Andrew Menzies-Gow and Patrick Mitchell and Andriana Papaioannou and Todor Popov and Celeste Porsbjerg and Laila Salameh and Concetta Sirena and Camille Taill{\'e} and Christian Taube and Yuji Tohda and Wechsler, {M. E.}",

note = "Acknowledgements In memory of Professor J. Mark Fitzgerald, the authors would like to acknowledge him for his valuable contribution to the development of the manuscript. The authors also acknowledge Ms. Daniela Morrone (MSc) of Cromsource, Verona, Italy for her contribution during the development of the manuscript and Mr. Joash Tan (BSc, Hons) of the Observational and Pragmatic Research Institute (OPRI), for editorial and formatting assistance that supported the development of this publication. Funding information 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.",

year = "2022",

month = dec,

day = "23",

doi = "10.22541/au.166563547.79282253/v1",

language = "English",

journal = "Allergy",

issn = "0105-4538",

publisher = "John Wiley & Sons, Ltd (10.1111)",

}

TY - JOUR

T1 - Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in severe asthma patients eligible for both

AU - Price, David

AU - pfeffer, paul

AU - Ali, Nasloon

AU - Murray, Ruth

AU - Ulrik, Charlotte

AU - Tran, Trung

AU - Maspero, Jorge

AU - Peters, Matthew

AU - Christoff, George

AU - Sadatsafavi, Mohsen

AU - Torres-Duque, Carlos A.

AU - Altraja, Alan

AU - Lehtimäki, Lauri

AU - Papadopoulos, Nikolaos

AU - Salvi, Sundeep

AU - Costello, Richard W.

AU - Cushen, Breda

AU - Heffler, Enrico

AU - Iwanaga, Takashi

AU - Al-Ahmad, Mona

AU - Larenas-Linnemann, Désirée

AU - Kuna, Piotr

AU - Fonseca, João

AU - Al-Lehebi, Riyad

AU - Rhee, Chin Kook

AU - Llano, Luis Perez de

AU - Perng, Diahn-Wang

AU - Mahboub, Bassam

AU - Wang, Eileen

AU - Goh, Yun Yi Celine

AU - Lyu, Juntao

AU - Newell, Anthony

AU - Alacqua, Marianna

AU - Bhutani, Mohit

AU - Bjermer, Leif

AU - Björnsdóttir, Unnur Steina

AU - Bourdin, Arnaud

AU - Bülow, Anna Von

AU - Busby, John

AU - Canonica, Walter

AU - Cosio, Borja G

AU - Dorscheid, Delbert

AU - Esquerre, Mariana Muñoz

AU - FitzGerald, Mark

AU - Gil, Esther Garcia

AU - Gibson, Peter Gerard

AU - Heaney, Liam

AU - Hew, Mark

AU - Hilberg, Ole

AU - Hoyte, Flavia

AU - Jackson, David

AU - Koh, Mariko

AU - Ko, Hsin-Kuo

AU - Lee, Jae Ha

AU - Lehmann, Sverre

AU - Loureiro, Claudia Chaves

AU - Ludviksdottir, Dora

AU - Menzies-Gow, Andrew

AU - Mitchell, Patrick

AU - Papaioannou, Andriana

AU - Popov, Todor

AU - Porsbjerg, Celeste

AU - Salameh, Laila

AU - Sirena, Concetta

AU - Taillé, Camille

AU - Taube, Christian

AU - Tohda, Yuji

AU - Wechsler, M. E.

N1 - Acknowledgements In memory of Professor J. Mark Fitzgerald, the authors would like to acknowledge him for his valuable contribution to the development of the manuscript. The authors also acknowledge Ms. Daniela Morrone (MSc) of Cromsource, Verona, Italy for her contribution during the development of the manuscript and Mr. Joash Tan (BSc, Hons) of the Observational and Pragmatic Research Institute (OPRI), for editorial and formatting assistance that supported the development of this publication. Funding information 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.

PY - 2022/12/23

Y1 - 2022/12/23

N2 - BackgroundPatients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life.MethodsThis was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term366 oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance and hospital admissions.ResultsIn the matched analysis (n=350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p372 experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs 20.55% reduction; p=0.023).) There was some evidence to suggest that patients treated with anti374 IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43).ConclusionsIn real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes, however anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use.

AB - BackgroundPatients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life.MethodsThis was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term366 oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance and hospital admissions.ResultsIn the matched analysis (n=350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p372 experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs 20.55% reduction; p=0.023).) There was some evidence to suggest that patients treated with anti374 IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43).ConclusionsIn real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes, however anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use.

KW - biologics

KW - exacerbation

KW - ISAR

KW - real life

KW - oral corticosteroids

U2 - 10.22541/au.166563547.79282253/v1

DO - 10.22541/au.166563547.79282253/v1

M3 - Article

JO - Allergy

JF - Allergy

SN - 0105-4538

ER -

Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in severe asthma patients eligible for both

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