Association between T2-related comorbidities and effectiveness of biologics in severe asthma

Michael E. Wechsler, Ghislaine Scelo, Désirée E.S. Larenas-Linnemann, Carlos A. Torres-Duque, Jorge Maspero, Trung N. Tran, Ruth B. Murray, Neil Martin, Andrew N. Menzies-Gow, Mark Hew, Matthew J. Peters, Peter G. Gibson, George C. Christoff, Todor A. Popov, Andréanne Côté, Celine Bergeron, Delbert Dorscheid, J. Mark FitzGerald, Kenneth R. Chapman, Louis Philippe BouletMohit Bhutani, Mohsen Sadatsafavi, Libardo Jiménez-Maldonado, Mauricio Duran-Silva, Bellanid Rodriguez, Carlos Andres Celis-Preciado, Diana Jimena Cano-Rosales, Ivan Solarte, Maria Jose Fernandez-Sanchez, Patricia Parada-Tovar, Anna von Bülow, Anne Sofie Bjerrum, Charlotte S. Ulrik, Karin Dahl Assing, Linda Makowska Rasmussen, Susanne Hansen, Alan Altraja, Arnaud Bourdin, Camille Taille, Jeremy Charriot, Nicolas Roche, Andriana I. Papaioannou, Konstantinos Kostikas, Nikolaos G. Papadopoulos, Sundeep Salvi, Deirdre Long, Patrick D. Mitchell, Richard Costello, Concetta Sirena, Cristina Cardini, Enrico Heffler, Francesca Puggioni, Giorgio Walter Canonica, Giuseppe Guida, Takashi Iwanaga, Mona Al-Ahmad, Ulises García, Piotr Kuna, João A. Fonseca, Riyad Al-Lehebi, Mariko S. Koh, Chin Kook Rhee, Borja G. Cosio, Luis Perez de Llano, Diahn Warng Steve Perng, Erick Wan Chun Huang, Hao Chien Wang, Ming Ju Tsai, Bassam Mahboub, Laila Ibraheem Jaber Salameh, David J. Jackson, John Busby, Liam G. Heaney, Paul E. Pfeffer, Amanda Grippen Goddard, Eileen Wang, Flavia C.L. Hoyte, Nicholas M. Chapman, Rohit Katial, Victoria Carter, Lakmini Bulathsinhala, Neva Eleangovan, Con Ariti, Juntao Lyu, Celeste Porsbjerg, David B. Price

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6 Citations (Scopus)
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Rationale: Previous studies investigating the impact of comorbidities on the effectiveness of biologic agents have been relatively small and of short duration and have not compared classes of biologic agents. 

Objectives: To determine the association between type 2-related comorbidities and biologic agent effectiveness in adults with severe asthma (SA). 

Methods: This cohort study used International Severe Asthma Registry data from 21 countries (2017-2022) to quantify changes in four outcomes before and after biologic therapy-annual asthma exacerbation rate, FEV1% predicted, asthma control, and long-term oral corticosteroid daily dose-in patients with or without allergic rhinitis, chronic rhinosinusitis (CRS) with or without nasal polyps (NPs), NPs, or eczema/atopic dermatitis. 

Measurements and Main Results: Of 1,765 patients, 1,257, 421, and 87 initiated anti-IL-5/5 receptor, anti-IgE, and anti-IL-4/13 therapies, respectively. In general, pre- versus post-biologic therapy improvements were noted in all four asthma outcomes assessed, irrespective of comorbidity status. However, patients with comorbid CRS with or without NPs experienced 23% fewer exacerbations per year (95% CI, 10-35%; P < 0.001) and had 59% higher odds of better post-biologic therapy asthma control (95% CI, 26-102%; P < 0.001) than those without CRS with or without NPs. Similar estimates were noted for those with comorbid NPs: 22% fewer exacerbations and 56% higher odds of better post-biologic therapy control. Patients with SA and CRS with or without NPs had an additional FEV1% predicted improvement of 3.2% (95% CI, 1.0-5.3; P = 0.004), a trend that was also noted in those with comorbid NPs. The presence of allergic rhinitis or atopic dermatitis was not associated with post-biologic therapy effect for any outcome assessed. 

Conclusions: These findings highlight the importance of systematic comorbidity evaluation. The presence of CRS with or without NPs or NPs alone may be considered a predictor of the effectiveness of biologic agents in patients with SA.

Original languageEnglish
Pages (from-to)262-272
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number3
Publication statusPublished - 01 Feb 2024


  • allergic rhinitis
  • chronic rhinosinusitis
  • nasal polyposis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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