Severe Asthma: Therapies

• Would biologic use patterns be similar for patients in different countries?

• Would the persistence of biologic use in patients be high internationally?

• What are the factors (e.g. patient profile, biologic type, prescription requirements of biologics) that may influence patterns of biologic use for severe asthma? 

• What are the predictors of responders and non-responders to biologic treatments (e.g. anti-lgE and anti-lL5)? 

• Prior research from clinical trials has shown the efficacy of individual biological treatments in reducing exacerbations and improving asthma control within specific severe asthma populations (only 5.3% of severe asthma patients are eligible for these trials). However, there has been no prior research or knowledge on the impact of switching patients between biologic treatments because all trials have been conducted independently. 

  SIE studies from OPRI have shown that:

  • 9% of patients with severe asthma switched once or twice to a second or third biologic

  • 84% continued on the second biologic and 11% switched again to a third biologic (75% persisted on the third biologic) 

  • Switchers were independently associated with more ER visits as compared to continuers (adjusted: 2.12 (1.39-3.24)

  • Switchers were independently more likely to have an increase in LTOCS dose post-therapy as compared to continuers. (adjusted: 3.77 (1.71-4.37)

  • Switchers were more than 3 times more likely to be uncontrolled post-therapy, OR: 3.10 (95% CI 2.23-4.09)

  • Switchers were more likely to have an increased incidence rate of exacerbation post-therapy as compared to continuers (1.83 (1.51-2.22¬)

• The results of this study have generated a new research question: “Can we predict patients who will go on to switch biological treatment using new biomarkers for asthma diagnosis, prognosis, and response to treatment?”.

• If the answer is proved to be yes, it would be proposed to move to phase 2 of R&D: to develop new treatment solutions based on the new knowledge gained in phase 1 for experimental study.

Real-world application

• New precision medicine technology is required and is in development to support more aggressive biologic treatment decisions.

• Development of new biologics for those who do not respond to existing treatment options, and for those who regularly switch treatment options due to unattained desired/expected outcome.

• The use of biologics in severe asthma only grew dramatically in the last decade. Currently, there are only 5 approved biologics for asthma, where some may not be accessible or approved for use in certain countries.

• As compared to other medications for asthma, biologics are significantly more expensive. Due to high costs, biologics are not administered widely across the world. Little is thus known about the patterns of biologic use in real-life.