ISAR recently held a virtual collaborators meeting on 15th September and it was a huge success! With 88 people from 25 countries spread across the globe, it was an excellent opportunity to get our collaborators up to speed on the latest updates from ISAR, as well as provide a forum for productive discussion.
Here are some key highlights from the meeting:
ISAR UPDATES
Global
- Currently engaged with over 30 countries, data being shared by 20 countries over 166 sites
Research
- Holds data from 9,420 patients (inclusive of retrospective data). The aim is to have data from 10,000+ patients by 2021.
Ongoing Data Initiatives
- ISAR’s ultimate goal is to move towards a self-sustaining database and be integrated into routine clinical management.
- We will provide quality improvement reports that give a clinical overview at a country- and site-level; these will aid in understanding where each site stands compared to sites locally and globally in terms of severe asthma management. It will also help fill in any gaps in care.
- The ISAR Patient Questionnaire will aid in collecting data on the patient’s perspective as well as other valuable data such as data on patients’ CoVID-19 experience. This questionnaire is available online and is optional.
- Free-text mining data efforts are also in place to maximize the amount of data collected.
Publications
- The ISAR Protocol is now in print in BMC Medical Research Methodology, and a slide deck for this manuscript can be found on the ISAR website here.
Seven other manuscripts are in the publication stage:
Six abstracts were presented at ATS 2020. Some interesting findings:
- The eosinophilic asthma phenotype is much more common than previously thought – GINA estimates ~50% of severe asthma patients are of the eosinophilic phenotype, whereas ISAR data shows that it is above 80%.
- Exacerbations are linked to lung function decline – but the greatest decline is noted in younger patients, presenting an excellent opportunity for early intervention.
– Three projects (FIRE, BEAM and the ISAR Inventory study) are planned for 2021.
Projects that are open for collaborators to join
BEAM – Defining and Characterising Responders to Biologic TrEAtment In Severe AsthMa Patients
- The project aim is to operationally define non-responders, responders and super-responders to biologic treatment via clinical indicators, such as exacerbations, OCS dose and asthma control and describe baseline demographic and clinical characteristics across the two groups.
PRISM – ImPact of ComoRbidity In Severe AsthMa
- This project sets out to illustrate the prevalence of comorbidities upon enrolling into ISAR among a real-life severe asthma cohort, and subsequently to characterise these patients, stratified by therapy (e.g. long-term OCS, biologic use).
LUMINANT – Describe the CLinical OUtcome Before and After Biologic TreatMent by BIologic Class, by INdividuAl Biologic, and by Subgroups of BaseliNe CharacTeristics
- The aim of this project is to describe clinical outcomes before and after biologic treatment by biologic class, by individual biologic, and by subgroups of baseline characteristics.
Academic
RADIANT – ExploRing Differences in Asthma DIsease Severity ANd PaThways: Variation By Ethnicity And Socioeconomic Status
- The primary aim of this study is to investigate differences in the severity of asthma between patients from distinct ethnic and socioeconomic groups in the UK. We will additionally explore disparities in the asthma care pathway to identify reasons for these differences.
- Hidden Severe Asthma within the COPD population
This project aims to identify and characterise a treatable severe asthma cohort that could respond to biologic treatment within a global population of COPD or ACO. - Identify Predictors (e.g. biomarkers) of Response to Biologics
- This project will look at identifying independent predictors of clinical response (no/partial/high) to biologic therapy and evaluate baseline biomarkers that predict a response to biologics.
Please contact Audrey Ang at audrey@optimumpatientcare.
Open Discussion on Ongoing Projects
Hidden Severe Asthma within the COPD population
- Data shows that patients who have never smoked and present with fixed airway obstruction are diagnosed with asthma; patients with the exact same clinical presentation and history but have smoked/are smokers get diagnosed with COPD.
- It is therefore likely that some COPD patients are actually severe asthma patients but are not given access to biologic treatments.
- The OPCRD database (a UK primary care database) will also be used for this study to capture the COPD population.
- South Korea has good data for ACOS patients – it can easily be combined with ISAR and OPCRD data for this study.
SUNNIE – Biologics in Severe Asthma: UtilizatioN PatterNs, Causes for DIscontinuation and SwitchEs
- May not be possible to look at whether patients who switched at 12 months already had certain characteristics different from others at 6 months as ISAR data is collected on an annual basis.
- Could potentially send questions to collaborators on their switch patients to aid in collecting this data specifically. These questions could also assess recall bias – especially in older patients.
FIRE – Comparative EfFectiveness of Initiating Anti-IL5 versus Anti-IgE in SeveRe Asthma Patients Eligible For Both Modalities
- The protocol can be shared with anyone who hasn’t received it.
- Overlap with OCS should also be evaluated when it comes to comorbidities in each patient group.
ACTION: To compare the prevalence of comorbidities between maintenance OCS users and non-maintenance OCS users - Note that the duration of maintenance OCS use is shorter in anti-IL5 as compared to anti-IgE patients – could be due to biologic reimbursement criteria.
- Another source of bias to consider is the fact that omalizumab was the only available biologic for quite some time; once anti-IL5 was available, many patients were immediately switched over.
BEAM – Defining and Characterising Responders to Biologic TrEAtment In Severe AsthMa Patients
- Would be useful to have patient input when assessing patient response; can be in the form of patients joining the steering committee as well as quality of life data.
- If anyone has patient representatives that are already involved in projects, please do let us know.
- The ISAR Patient Response Platform will also enable patients’ perspectives to be captured.
PATH – Patterns of AsThma Onset and Associated PHenotypes
- Possibility of lowering the age for recruitment into ISAR to 12 years and above.
- Gender does change the pattern of the age of asthma onset distribution – but not by much.
