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

Paul E Pfeffer^{1

2}, Nasloon Ali^{3

4}, Ruth Murray⁴, Charlotte Ulrik⁵, Trung N Tran⁶, Jorge Maspero^{7

8}, Matthew Peters⁹, George C Christoff¹⁰, Mohsen Sadatsafavi¹¹, Carlos A Torres-Duque¹², Alan Altraja¹³, Lauri Lehtimäki^{14

15}, Nikolaos G Papadopoulos^{16

17}, Sundeep Salvi¹⁸, Richard W Costello¹⁹, Breda Cushen²⁰, Enrico Heffler^{21

22}, Takashi Iwanaga²³, Mona Al-Ahmad²⁴, Désirée Larenas-Linnemann²⁵, Piotr Kuna²⁶, João A Fonseca²⁷, Riyad Al-Lehebi^{28

29}, Chin Kook Rhee³⁰, Luis Perez-de-Llano^{31

32}, Diahn-Warng Perng Steve^{33

34}, Bassam Mahboub^{35

36}, Eileen Wang^{37

38}, Celine Goh^{3

4}, Juntao Lyu^{3

39}, Anthony Newell^{3

39}, Marianna Alacqua⁴⁰, Andrey S Belevskiy⁴¹, Mohit Bhutani⁴², Leif Bjermer⁴³, Unnur Bjornsdottir⁴⁴, Arnaud Bourdin⁴⁵, Anna von Bulow⁴⁶, John Busby⁴⁷, Giorgio Walter Canonica^{21

22}, Borja G Cosio⁴⁸, Delbert R Dorscheid⁴⁹, Mariana Muñoz-Esquerre^{50

51}, J Mark FitzGerald⁵², Esther Garcia Gil⁵³, Peter G Gibson^{54

55}, Liam G Heaney⁵⁶, Mark Hew^{57

58}, Ole Hilberg⁵⁹, Flavia Hoyte^{37

38}, David J Jackson^{60

61}, Mariko Siyue Koh^{62

63}, Hsin-Kuo Bruce Ko⁶⁴, Jae Ha Lee⁶⁵, Sverre Lehmann^{66

67}, Cláudia Chaves Loureiro⁶⁸, Dóra Lúðvíksdóttir^{69

70}, Andrew N Menzies-Gow⁷¹, Patrick Mitchell⁷², Andriana I Papaioannou⁷³, Todor A Popov⁷⁴, Celeste M Porsbjerg⁷⁵, Laila Salameh^{35

36}, Concetta Sirena⁷⁶, Camille Taillé⁷⁷, Christian Taube⁷⁸, Yuji Tohda⁷⁹, Michael E Wechsler⁸⁰, David B Price^{3

4

81}

Affiliations

¹ Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.
² Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
³ Observational and Pragmatic Research Institute, Singapore, Singapore.
⁴ Optimum Patient Care Global, Cambridge, UK.
⁵ Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.
⁶ AstraZeneca, Gaithersburg, Maryland, USA.
⁷ Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina.
⁸ University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina.
⁹ Department of Thoracic Medicine, Concord Hospital, Sydney, Australia.
¹⁰ Medical University-Sofia, Faculty of Public Health, Sofia, Bulgaria.
¹¹ Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
¹² CINEUMO, Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia.
¹³ Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia.
¹⁴ Allergy Centre, Tampere University Hospital, Tampere, Finland.
¹⁵ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
¹⁶ Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK.
¹⁷ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
¹⁸ Pulmocare Research and Education Foundation, Pune, India.
¹⁹ Department of Respiratory Medicine, Clinical Research Centre, Smurfit Building Beaumont Hospital, Dublin, Ireland.
²⁰ Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland.
²¹ Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milan, Italy.
²² Department of Biomedical Sciences, Humanitas University, Milan, Italy.
²³ Center for General Medical Education and Clinical Training, Kindai University Hospital, Osakasayama, Japan.
²⁴ Microbiology Department, College of Medicine, Kuwait University, Kuwait, Al-Rashed Allergy Center, Kuwait, Kuwait.
²⁵ Directora Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Ciudad de México, Mexico.
²⁶ Division of Internal Medicine, Asthma and Allergy Medical University of Łódź, Łódź, Poland.
²⁷ Health Information and Decision Sciences Department (MEDCIDS), CINTESIS@RiSE, Faculty of Medicine of University of Porto, Porto, Portugal.
²⁸ Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia. Alfaisal University, Riyadh, Saudi Arabia.
²⁹ Alfaisal University, Riyadh, Saudi Arabia.
³⁰ Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
³¹ Pneumology Service, Lucus Augusti University Hospital, Cervo, Spain.
³² Biodiscovery Research Group, Health Research Institute of Santiago de Compostela, Santiago, Spain.
³³ Division of Clinical Respiratory Physiology Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan.
³⁴ COPD Assembly of the Asian Pacific Society of Respirology, Hong Kong, China.
³⁵ College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
³⁶ Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
³⁷ Department of Medicine, Division of Allergy & Clinical Immunology, National Jewish Health, Denver, Colorado, USA.
³⁸ Department of Medicine, Division of Allergy & Clinical Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA.
³⁹ Optimum Patient Care, Queensland, Australia.
⁴⁰ CSL Behring SpA, Milan, Italy.
⁴¹ Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Moscow, Russian Federation.
⁴² Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada.
⁴³ Department of Clinical Sciences, Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden.
⁴⁴ Department of Allergy and Respiratory Medicine, University Hospital, Reykjavik, Iceland.
⁴⁵ PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France.
⁴⁶ Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.
⁴⁷ Centre for Public Health, Queen's University Belfast, Belfast, UK.
⁴⁸ Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain.
⁴⁹ Department of Medicine, Center for Heart, Lung Innovation, The University of British Columbia, Vancouver, Canada.
⁵⁰ Department of Respiratory Medicine, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
⁵¹ University of Barcelona, Barcelona, Spain.
⁵² Department of Medicine, The University of British Columbia, Vancouver, Canada.
⁵³ AstraZeneca, Barcelona, Spain.
⁵⁴ Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia.
⁵⁵ Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia.
⁵⁶ Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.
⁵⁷ Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia.
⁵⁸ Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁵⁹ Medical department, Vejle University Hospital, Vejle, Denmark.
⁶⁰ UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust, London, England.
⁶¹ School of Immunology & Microbial Sciences, King's College London, London, UK.
⁶² Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.
⁶³ SingHealth Duke-NUS Lung Centre, Singapore, Singapore.
⁶⁴ Department of Chest Medicine, Division of Respiratory Therapy, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶⁵ Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
⁶⁶ Department of Clinical Science, Section of Thoracic Medicine, University of Bergen, Bergen, Norway.
⁶⁷ Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
⁶⁸ Pulmonology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal & Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁶⁹ Department of Allergy, University Hospital, Reykjavik, Iceland.
⁷⁰ Department of Respiratory Medicine, University Hospital, Reykjavik, Iceland.
⁷¹ Royal Brompton & Harefield Hospitals, London, UK.
⁷² School of Medicine, Trinity College Dublin, Dublin, Ireland.
⁷³ 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece.
⁷⁴ University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria.
⁷⁵ Department of Respiratory Medicine and Infections Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark.
⁷⁶ Severe Asthma Network Italy (SANI), Milan, Italy.
⁷⁷ Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université de Paris, Paris, France.
⁷⁸ Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany.
⁷⁹ Kindai University Hospital, Osakasayama, Japan.
⁸⁰ NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colorado, USA.
⁸¹ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.

PMID: 36929509
DOI: 10.1111/all.15711

Comparative Study

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

Paul E Pfeffer et al. Allergy. 2023 Jul.

. 2023 Jul;78(7):1934-1948.

doi: 10.1111/all.15711. Epub 2023 Mar 27.

Authors

Affiliations

¹ Department of Respiratory Medicine, Barts Health NHS Trust, London, UK.
² Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
³ Observational and Pragmatic Research Institute, Singapore, Singapore.
⁴ Optimum Patient Care Global, Cambridge, UK.
⁵ Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.
⁶ AstraZeneca, Gaithersburg, Maryland, USA.
⁷ Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina.
⁸ University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina.
⁹ Department of Thoracic Medicine, Concord Hospital, Sydney, Australia.
¹⁰ Medical University-Sofia, Faculty of Public Health, Sofia, Bulgaria.
¹¹ Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
¹² CINEUMO, Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia.
¹³ Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia.
¹⁴ Allergy Centre, Tampere University Hospital, Tampere, Finland.
¹⁵ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
¹⁶ Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK.
¹⁷ Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
¹⁸ Pulmocare Research and Education Foundation, Pune, India.
¹⁹ Department of Respiratory Medicine, Clinical Research Centre, Smurfit Building Beaumont Hospital, Dublin, Ireland.
²⁰ Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland.
²¹ Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milan, Italy.
²² Department of Biomedical Sciences, Humanitas University, Milan, Italy.
²³ Center for General Medical Education and Clinical Training, Kindai University Hospital, Osakasayama, Japan.
²⁴ Microbiology Department, College of Medicine, Kuwait University, Kuwait, Al-Rashed Allergy Center, Kuwait, Kuwait.
²⁵ Directora Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Ciudad de México, Mexico.
²⁶ Division of Internal Medicine, Asthma and Allergy Medical University of Łódź, Łódź, Poland.
²⁷ Health Information and Decision Sciences Department (MEDCIDS), CINTESIS@RiSE, Faculty of Medicine of University of Porto, Porto, Portugal.
²⁸ Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia. Alfaisal University, Riyadh, Saudi Arabia.
²⁹ Alfaisal University, Riyadh, Saudi Arabia.
³⁰ Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
³¹ Pneumology Service, Lucus Augusti University Hospital, Cervo, Spain.
³² Biodiscovery Research Group, Health Research Institute of Santiago de Compostela, Santiago, Spain.
³³ Division of Clinical Respiratory Physiology Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan.
³⁴ COPD Assembly of the Asian Pacific Society of Respirology, Hong Kong, China.
³⁵ College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.
³⁶ Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
³⁷ Department of Medicine, Division of Allergy & Clinical Immunology, National Jewish Health, Denver, Colorado, USA.
³⁸ Department of Medicine, Division of Allergy & Clinical Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA.
³⁹ Optimum Patient Care, Queensland, Australia.
⁴⁰ CSL Behring SpA, Milan, Italy.
⁴¹ Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Moscow, Russian Federation.
⁴² Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada.
⁴³ Department of Clinical Sciences, Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden.
⁴⁴ Department of Allergy and Respiratory Medicine, University Hospital, Reykjavik, Iceland.
⁴⁵ PhyMedExp, Univ Montpellier, CNRS, INSERM, Montpellier, France.
⁴⁶ Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.
⁴⁷ Centre for Public Health, Queen's University Belfast, Belfast, UK.
⁴⁸ Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain.
⁴⁹ Department of Medicine, Center for Heart, Lung Innovation, The University of British Columbia, Vancouver, Canada.
⁵⁰ Department of Respiratory Medicine, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
⁵¹ University of Barcelona, Barcelona, Spain.
⁵² Department of Medicine, The University of British Columbia, Vancouver, Canada.
⁵³ AstraZeneca, Barcelona, Spain.
⁵⁴ Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia.
⁵⁵ Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia.
⁵⁶ Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.
⁵⁷ Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia.
⁵⁸ Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁵⁹ Medical department, Vejle University Hospital, Vejle, Denmark.
⁶⁰ UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust, London, England.
⁶¹ School of Immunology & Microbial Sciences, King's College London, London, UK.
⁶² Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore, Singapore.
⁶³ SingHealth Duke-NUS Lung Centre, Singapore, Singapore.
⁶⁴ Department of Chest Medicine, Division of Respiratory Therapy, Taipei Veterans General Hospital, Taipei, Taiwan.
⁶⁵ Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
⁶⁶ Department of Clinical Science, Section of Thoracic Medicine, University of Bergen, Bergen, Norway.
⁶⁷ Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
⁶⁸ Pulmonology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal & Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
⁶⁹ Department of Allergy, University Hospital, Reykjavik, Iceland.
⁷⁰ Department of Respiratory Medicine, University Hospital, Reykjavik, Iceland.
⁷¹ Royal Brompton & Harefield Hospitals, London, UK.
⁷² School of Medicine, Trinity College Dublin, Dublin, Ireland.
⁷³ 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece.
⁷⁴ University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria.
⁷⁵ Department of Respiratory Medicine and Infections Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark.
⁷⁶ Severe Asthma Network Italy (SANI), Milan, Italy.
⁷⁷ Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université de Paris, Paris, France.
⁷⁸ Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany.
⁷⁹ Kindai University Hospital, Osakasayama, Japan.
⁸⁰ NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colorado, USA.
⁸¹ Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.

PMID: 36929509
DOI: 10.1111/all.15711

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-term-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; p < 0.001) and 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 anti-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.

Keywords: ISAR; biologics; exacerbation; oral corticosteroids; real life.

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References

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

Affiliations

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

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical