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Article Dans Une Revue Journal of Asthma and Allergy Année : 2022

Characterization of Patients in the International Severe Asthma Registry with High Steroid Exposure Who Did or Did Not Initiate Biologic Therapy

1 NUS - National University of Singapore
2 UBC - University of British Columbia
3 AstraZeneca
4 Kuwait University
5 University of Tartu
6 KFMC - King Fahad Medical City [Riyadh]
7 Alfaisal University
8 University of Alberta
9 Skane University Hospital [Lund]
10 Aarhus University Hospital
11 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
12 QUB - Queen's University [Belfast]
13 IRCCS Milan - Istituto Clinico Humanitas [Milan]
14 Medical University of Sofia [Bulgarie]
15 IdISBa - Fundació Institut d'Investigació Sanitària Illes Balears
16 HB - Hôpital de Beaumont [Dublin, Ireland]
17 University of British Columbia [Vancouver]
18 Universidade do Porto = University of Porto
19 Konkuk University [Seoul]
20 Alfred Health
21 Monash University [Melbourne]
22 NJH - National Jewish Health
23 University of Colorado Anschutz [Aurora]
24 Kindai University
25 Guy's and St Thomas' NHS Foundation Trust
26 King‘s College London
27 Plymouth University
28 NUH - National University Hospital [Singapore]
29 MUL - Medical University of Łódź
30 UiB - University of Bergen
31 Tampere University Hospital
32 UoS - University of Sharjah
33 MBRU - Mohammed Bin Rashid University of Medicine and Health Sciences
34 Royal Brompton and Harefield NHS Foundation Trust
35 University of Manchester [Manchester]
36 University of Athens Medical School [Athens]
37 NKUA - National and Kapodistrian University of Athens
38 IDIS - Instituto de Investigación Sanitaria de Santiago de Compostela / Health Research Institute of Santiago de Compostela
39 Taipei Medical University
40 The University of Sydney
41 Barts Health NHS Trust [London, UK]
42 UCPH - University of Copenhagen = Københavns Universitet
43 Catholic University of Korea
44 IISER Pune - Indian Institute of Science Education and Research Pune
45 CIC Hôpital Bichat
46 AöR - University Hospital Essen
47 Copenhagen University Hospital
48 University of Ulsan
49 University of Aberdeen
Mohsen Sadatsafavi
Trung N. Tran
  • Fonction : Auteur
Ruth Murray
  • Fonction : Auteur
Chong Boon Nigel Wong
Nasloon Ali
Cono Ariti
  • Fonction : Auteur
Esther Garcia Gil
  • Fonction : Auteur
Anthony Newell
Marianna Alacqua
  • Fonction : Auteur
Mona Al-Ahmad
Alan Altraja
  • Fonction : Auteur
Leif Bjermer
Lakmini Bulathsinhala
  • Fonction : Auteur
Anna von Bülow
  • Fonction : Auteur
Victoria Carter
  • Fonction : Auteur
George Christoff
Richard Costello
Kwang Ha Yoo
Ole Hilberg
Takashi Iwanaga
Rupert Jones
Désirée Larenas-Linnemann
Lauri Lehtimäki
Juntao Lyu
Jorge Maspero
  • Fonction : Auteur
Concetta Sirena
  • Fonction : Auteur
Todor Popov
Carlos Torres-Duque
Charlotte Ulrik
Seung Won Ra
Michael Wechsler
David Price


Background: Many severe asthma patients with high oral corticosteroid exposure (HOCS) often do not initiate biologics despite being eligible. This study aimed to compare the characteristics of severe asthma patients with HOCS who did and did not initiate biologics. Methods: Baseline characteristics of patients with HOCS (long-term maintenance OCS therapy for at least 1 year, or ≥4 courses of steroid bursts in a year) from the International Severe Asthma Registry (ISAR;, who initiated or did not initiate biologics (anti-lgE, anti-IL5/5R or anti-IL4R), were described at the time of biologic initiation or registry enrolment. Statistical relationships were tested using Pearson's chi-squared tests for categorical variables, and t-tests for continuous variables, adjusting for potential errors in multiple comparisons. Results: Between January 2015 and February 2021, we identified 1412 adult patients with severe asthma from 19 countries that met our inclusion criteria of HOCS, of whom 996 (70.5%) initiated a biologic and 416 (29.5%) did not. The frequency of biologic initiation varied across geographical regions. Those who initiated a biologic were more likely to have higher blood eosinophil count (483 vs 399 cells/µL, p=0.003), serious infections (49.0% vs 13.3%, p<0.001), nasal polyps (35.2% vs 23.6%, p<0.001), airflow limitation (56.8% vs 51.8%, p=0.013), and uncontrolled asthma (80.8% vs 73.2%, p=0.004) despite greater conventional treatment adherence than those who did not start a biologic. Both groups had similar annual asthma exacerbation rates in the previous 12 months (5.7 vs 5.3, p=0.147). Conclusion: Around one third of severe HOCS asthma patients did not receive biologics despite a similar high burden of asthma exacerbations as those who initiated a biologic therapy. Other disease characteristics such as eosinophilic phenotype, serious infectious events, nasal polyps, airflow limitation and lack of asthma control appear to dictate biologic use.

Dates et versions

hal-04391095 , version 1 (12-01-2024)



Wenjia Chen, Mohsen Sadatsafavi, Trung N. Tran, Ruth Murray, Chong Boon Nigel Wong, et al.. Characterization of Patients in the International Severe Asthma Registry with High Steroid Exposure Who Did or Did Not Initiate Biologic Therapy. Journal of Asthma and Allergy, 2022, Volume 15, pp.1491-1510. ⟨10.2147/JAA.S377174⟩. ⟨hal-04391095⟩
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