Real World Biologic Use and Switch Patterns in Severe Asthma: Data from the International Severe Asthma Registry and the US CHRONICLE Study

AN Menzies-Gow, C McBrien, B Unni, CM Porsbjerg, M Al-Ahmad, CS Ambrose, K Dahl Assing, A von Bülow, John Busby, BG Cosio, JM FitzGerald, E Garcia Gil, S Hansen, Liam G Heaney, M Hew, DJ Jackson, M Kallieri, S Loukides, NL Lugogo, AI PapaioannouD Larenas-Linnemann, WC Moore, LA Perez-de-Llano, LM Rasmussen, JM Schmid, S Siddiqui, M Alacqua, TN Tran, C Suppli Ulrik, JW Upham, E Wang, L Bulathsinhala, VA Carter, I Chaudhry, N Eleangovan, RB Murray, CA Price, DB Price

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43 Citations (Scopus)
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Introduction: International registries provide opportunities to describe use of biologics for treating severe asthma in current clinical practice. Our aims were to describe real-life global patterns of biologic use (continuation, switches, and discontinuations) for severe asthma, elucidate reasons underlying these patterns, and examine associated patient-level factors.

Methods: This was a historical cohort study including adults with severe asthma enrolled into the International Severe Asthma Registry (ISAR;, 2015-2020) or the CHRONICLE Study (2018-2020) and treated with a biologic. Eleven countries were included (Bulgaria, Canada, Denmark, Greece, Italy, Japan, Kuwait, South Korea, Spain, UK, and USA). Biologic utilization patterns were defined: 1) continuing initial biologic; 2) stopping biologic treatment; or 3) switching to another biologic. Reasons for discontinuation/switching were recorded and comparisons drawn between groups.

Results: 3531 patients were included. Omalizumab was the most common initial biologic in 2015 (88.2%) and benralizumab in 2019 (29.6%). Most patients (79%; 2791/3531) continued their first biologic; 10.2% (356/3531) stopped; 10.8% (384/3531) switched. The most frequent first switch was from omalizumab to an anti–IL-5/5R (49.6%; 187/377). The most common subsequent switch was from one anti–IL-5/5R to another (44.4%; 20/45). Insufficient efficacy and/or adverse effects were the most frequent reasons for stopping/switching. Patients who stopped/switched were more likely to have a higher baseline blood eosinophil count and exacerbation rate, lower lung function, and greater health care resource utilization.

Conclusion: The description of real-life patterns of continuing, stopping, or switching biologics enhances our understanding of global biologic use. Prospective studies involving structured switching criteria could ascertain optimal strategies to identify patients who may benefit from switching.
Original languageEnglish
Pages (from-to)63-78
Number of pages16
JournalJournal of Asthma and Allergy
Publication statusPublished - 13 Jan 2022


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