A comparison of treatment response to biologics in asthma-COPD overlap and pure asthma: Findings from the PRISM study

Ji-Su Shim¹, Hyunkyoung Kim², Jae-Woo Kwon³, So-Young Park⁴, Sujeong Kim⁵, Byung-Keun Kim⁶, Young-Hee Nam⁷, Min-Suk Yang⁸, Mi-Yeong Kim⁹, Sae-Hoon Kim¹⁰, Byung-Jae Lee¹¹, Taehoon Lee¹², Sang-Ha Kim¹³, So Young Park¹⁴, Young-Joo Cho¹, Chan Sun Park¹⁵, Jae-Woo Jung¹⁶, Han-Ki Park^{5

17}, Joo-Hee Kim¹⁸, Jeong-Hee Choi¹⁹, Ji-Yong Moon²⁰, Ian Adcock²¹, Kian Fan Chung²¹, Min-Hye Kim¹, Tae-Bum Kim²; Precision Intervention in Severe Asthma (PRISM) study investigatorsa

Affiliations

¹ Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea.
² Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
³ Department of Allergy and Clinical Immunology, Kangwon National University School of Medicine, Chuncheon, South Korea.
⁴ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.
⁵ Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
⁶ Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
⁷ Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea.
⁸ Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
⁹ Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.
¹⁰ Department of Internal Medicine, Division of Allergy and Clinical Immunology, Seoul National University Bundang Hospital, Seongnam, South Korea.
¹¹ Departments of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
¹² Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
¹³ Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
¹⁴ Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea.
¹⁵ Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
¹⁶ Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.
¹⁷ Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea.
¹⁸ Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea.
¹⁹ Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea.
²⁰ Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
²¹ National Heart and Lung Institute, Imperial College London, United Kingdom.

PMID: 38093952
PMCID: PMC10716772
DOI: 10.1016/j.waojou.2023.100848

A comparison of treatment response to biologics in asthma-COPD overlap and pure asthma: Findings from the PRISM study

Ji-Su Shim et al. World Allergy Organ J. 2023.

. 2023 Dec 12;16(12):100848.

doi: 10.1016/j.waojou.2023.100848. eCollection 2023 Dec.

Authors

Affiliations

¹ Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea.
² Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
³ Department of Allergy and Clinical Immunology, Kangwon National University School of Medicine, Chuncheon, South Korea.
⁴ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.
⁵ Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
⁶ Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
⁷ Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea.
⁸ Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
⁹ Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.
¹⁰ Department of Internal Medicine, Division of Allergy and Clinical Immunology, Seoul National University Bundang Hospital, Seongnam, South Korea.
¹¹ Departments of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
¹² Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
¹³ Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
¹⁴ Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea.
¹⁵ Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
¹⁶ Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.
¹⁷ Division of Allergy and Clinical Immunology, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea.
¹⁸ Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea.
¹⁹ Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea.
²⁰ Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
²¹ National Heart and Lung Institute, Imperial College London, United Kingdom.

PMID: 38093952
PMCID: PMC10716772
DOI: 10.1016/j.waojou.2023.100848

Abstract

Background: Despite the increasing use of biologics in severe asthma, there is limited research on their use in asthma-chronic obstructive pulmonary disease overlap (ACO). We compared real-world treatment responses to biologics in ACO and asthma.

Methods: We conducted a multicenter, retrospective, cohort study using data from the Precision Medicine Intervention in Severe Asthma (PRISM). ACO was defined as post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.7 and a smoking history of >10 pack-years. Physicians selected biologics (omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab) based on each United States Food & Drug Administration (FDA) approval criteria.

Results: After six-month treatment with biologics, both patients with ACO (N = 13) and asthma (N = 81) showed positive responses in FEV1 (10.69 ± 17.17 vs. 11.25 ± 12.87 %, P = 0.652), Asthma Control Test score (3.33 ± 5.47 vs. 5.39 ± 5.42, P = 0.290), oral corticosteroid use (-117.50 ± 94.38 vs. -115.06 ± 456.85 mg, P = 0.688), fractional exhaled nitric oxide levels (-18.62 ± 24.68 vs. -14.66 ± 45.35 ppb, P = 0.415), sputum eosinophils (-3.40 ± 10.60 vs. -14.48 ± 24.01 %, P = 0.065), blood eosinophils (-36.47 ± 517.02 vs. -363.22 ± 1294.59, P = 0.013), and exacerbation frequency (-3.07 ± 4.42 vs. -3.19 ± 5.11, P = 0.943). The odds ratio for exacerbation and time-to-first exacerbation showed no significant difference after full adjustments, and subgroup analysis according to biologic type was also showed similar results.

Conclusions: Biologics treatment response patterns in patients with ACO and asthma were comparable, suggesting that biologics should be actively considered for ACO patients as well.

Keywords: Asthma; Asthma-COPD overlap; Biologics; Monoclonal antibodies; Treatment response.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Study population flow chart. Abbreviations: ACO, asthma-chronic obstructive pulmonary disease overlap; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; PY, pack-year.

**Fig. 2**
Kaplan–Meier curves for the time-to-first asthma exacerbation, according to each group. 2-1. ACO vs. Pure asthma 2-2. ACO vs. Pure asthma among mepolizumab and reslizumab users 2-3. ACO vs. Pure asthma among dupilumab users Abbreviations: ACO, asthma-chronic obstructive pulmonary disease overlap.

See this image and copyright information in PMC

References

1. Barczyk A., Maskey-Warzęchowska M., Górska K., et al. Asthma-COPD overlap-A discordance between patient populations defined by different diagnostic criteria. J Allergy Clin Immunol Pract. 2019;7(7):2326–2336.e2325. - PubMed
1. Leung C., Sin D.D. Asthma-COPD overlap: what are the important questions? Chest. 2022;161(2):330–344. - PubMed
1. Toledo-Pons N., van Boven J.F.M., Román-Rodríguez M., et al. ACO: time to move from the description of different phenotypes to the treatable traits. PLoS One. 2019;14(1) - PMC - PubMed
1. Fouka E., Papaioannou A.I., Hillas G., Steiropoulos P. Asthma-COPD overlap syndrome: recent insights and unanswered questions. J Personalized Med. 2022;12(5) - PMC - PubMed
1. Global Strategy for Asthma Management and Prevention . 2014. Global Initiative for Asthma.

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

A comparison of treatment response to biologics in asthma-COPD overlap and pure asthma: Findings from the PRISM study

Affiliations

A comparison of treatment response to biologics in asthma-COPD overlap and pure asthma: Findings from the PRISM study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources