Initiate Biologic Therapy Sooner in Uncontrolled Severe Asthma?

Patients with uncontrolled severe asthma need accelerated access to biologic therapy, say authors of a study presented at the 2021 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting, held in New Orleans, LA, from November 4 to 8.

While treatment escalation is recommended in patients with severe asthma that is considered uncontrolled based on significant symptoms or frequent exacerbations, real-world initiation of biologic therapy following exacerbations has not been well characterized in the United States.

In the CHRONICLE trial (ClinicalTrials.gov Identifier: NCT03373045), an ongoing observational study of patients with confirmed severe asthma treated by US subspecialists, researchers examined associations between exacerbations and biologic initiation, comparing patients who initiated biologic therapy up to 6 months prior to enrollment with patients who did not initiate biologic therapy prior to enrollment.

The researchers analyzed 959 patients, 565 of whom had an exacerbation while not receiving biologics. Among these patients, 233 (41%) subsequently initiated biologic therapy. Researchers found the proportion of patients initiating biologic therapy was the same for those with 1 vs more than 1 exacerbation. However, the median number of days between last exacerbation and biologic initiation was 70 days for patients with 1 exacerbation vs 36.5 days for patients with more than 1 exacerbation (P <.05). The investigators did not observe a significant association with timing of biologic initiation and comorbid conditions, exacerbation severity, or care received from allergists/immunologists vs pulmonologists.

They concluded, “Among US patients receiving subspecialist care for [severe asthma] and not receiving biologics, 4 in 10 uncontrolled patients with exacerbations initiated biologics.” They added, “Biologic initiation was significantly sooner in patients with [more than] 1 exacerbation. Expediting access to biologic therapy for patients with uncontrolled [severe asthma] should be explored.”

Reference

Genofre E, Nowojewski A, Scetinina T, Ambrose C. Timing of biologic initiation following exacerbations among US specialist-treated patients with severe asthma 8023. Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA.  Abstract P081.