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

• Published in: The World Allergy Organization journal 2023-12, Vol.16 (12), p.100848-100848, Article 100848
• Main Authors: Shim, Ji-Su, Kim, Hyunkyoung, Kwon, Jae-Woo, Park, So-Young, Kim, Sujeong, Kim, Byung-Keun, Nam, Young-Hee, Yang, Min-Suk, Kim, Mi-Yeong, Kim, Sae-Hoon, Lee, Byung-Jae, Lee, Taehoon, Kim, Sang-Ha, Park, So Young, Cho, Young-Joo, Park, Chan Sun, Jung, Jae-Woo, Park, Han-Ki, Kim, Joo-Hee, Choi, Jeong-Hee, Moon, Ji-Yong, Adcock, Ian, Chung, Kian Fan, Kim, Min-Hye, Kim, Tae-Bum
• Format: Article
• Language: English
• Subjects: Asthma; Asthma-COPD overlap; Biologics; Full Length; Monoclonal antibodies; Treatment response
• ISSN: 1939-4551; 1939-4551
• DOI: 10.1016/j.waojou.2023.100848

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. 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) 10 pack-years. Physicians selected biologics (omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab) based on each United States Food & Drug Administration (FDA) approval criteria. 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. Biologics treatment response patterns in patients with ACO and asthma were comparable, suggesting that biologics should be actively considered for ACO patients as well.