Published Articles
Characterization of patients in the International Severe Asthma Registry with high steroid exposure who did or did not initiate biologic therapy
Wenjia Chen, et al. J Asthma Allergy 2022; 15: 1491—1510
Almost one-third of severe asthma patients with high OCS exposure do not receive biologics
This was discovered in the first global study to compare patients with severe asthma and high oral corticosteroid (OCS) exposure (≥1 year of long-term OCS or ≥4 OCS bursts in a year) who did and did not initiate biologic therapy, assessing the factors that predict biologic treatment. The study also found that #biologic initiation very much depended on where patients lived! Check out what proportion of severe #asthma patients with high OCS exposure received a biologic in your country in the article.
Other potential drivers of biologic initiation appeared to be eosinophilic asthma defined in terms of elevated biomarkers for airway inflammation and uncontrolled asthma despite treatment adherence.
Asthma Exacerbations are Associated with a decline in Lung Function: A Longitudinal Population-Based Study
Soremekun S, et al. Thorax 2022 (Online First)
People with severe asthma have damaged bodies from repeated steroid courses and lung function impairment. Although asthma exacerbations are generally thought to accelerate lung function decline, there’s been mixed evidence in current literature. Using data from the Optimum Patient Care Research Database of 109,182 patients with asthma who were followed-up for 5 to 50 years, our newest publication provides robust evidence that asthma exacerbations are indeed associated with much faster lung function decline. More importantly, in patients between 18 and 39 years old, this association was stronger, and the speed of lung function decline was higher. Younger patients with repeated asthma exacerbations need earlier assessment and possible intervention with biologics.
Global Variability in Administrative Approval Prescription Criteria for Biologic Therapy in Severe Asthma
Porsbjerg C, et al. J Allergy Clin Immunol Pract 2022
Precision or country and post-code medicine?
This study showed a high degree of variability in ease of access to severe asthma biologics across countries. In fact, the vast majority of countries surveyed had more stringent access criteria than those stipulated by EMA! Our newly developed biologic accessibility score (BACS) allows you to see at a glance how easy or difficult it is to access biologics in your country.
Real-world biologic use and switch patterns in severe asthma: data from the International Severe Asthma Registry and the US CHRONICLE Study
Menzies Gow, et al. J Asthma Allergy 2022; 15: 63 – 78
Biologics for severe asthma: time to switch it up?
Ever wondered about the pattern of use of biologics in real-life? Or whether the first biologic prescribed to a patient is the best one for that individual? This study explored these questions and more, using data from both ISAR and CHRONICLE and found, quite surprisingly, that even in a world with multiple biologic choices for severe asthma only about 11% of patients switched from one biologic to another and even a smaller proportion (10%) stopped. Interestingly if a change to biologic therapy was made, the pattern of switch vs ditch was country dependent. Some countries like the US, UK and Spain leaned towards stopping, while others like Kuwait, Bulgaria, Canada, Denmark, South Korea, Italy and Greece were more likely to switch. So, are we getting it right from the get-go, or are we under-switching?
Impact of socioeconomic status on adult patients with asthma: a population-based cohort study from UK primary care
Busby J, et al. J Asthma Allergy 2021; 14: 1375 – 1388
In this study, we investigated the effects of socioeconomic status (SES) on clinical outcomes in a UK primary care asthma cohort (N=127,040) from the Optimum Patient Care Research Database (OPCRD). There was evidence of socioeconomic disparities, which had adverse effects on asthma outcomes. Patients from the most deprived quintile were more likely to have decreased peak flow, uncontrolled asthma, or an exacerbation during follow-up than those from the least deprived quintile, yet their rates of respiratory referrals remained comparable. This should raise clinical awareness that more deprived patients may have a greater need for specialist reviews and phenotype-targeted treatments like biologics. This study also demonstrated that the magnitude of the impact of SES on asthma outcomes was greater in patients who were older or from ethnic minority groups. Interventions to resolve socioeconomic disparities should be explored, both in the UK and globally, to improve overall asthma outcomes.
Asthma phenotyping in primary care: applying the International Severe Asthma Registry eosinophil phenotype algorithm across all asthma severities
Kerkhof M, et al. J Allergy Clin Immunol Pract 2021.
The ISAR eosinophil phenotype gradient algorithm, when re-applied in the Optimum Patient Care Research Database (OPCRD) and Clinical Practice Research Datalink (CPRD) cohort, found that eosinophilic asthma predominates in primary care and is associated with greater asthma severity and healthcare resource utilisation. This algorithm enables primary care physicians to identify and categorise patients into those with and without eosinophilic asthma and refer them, when appropriate, for phenotype-targeted treatment.
Eosinophilic and non-eosinophilic asthma: an expert consensus framework to characterize phenotypes in a global real-life severe asthma cohort
Heaney L, et al. CHEST 2021; 160(3): 814 – 830.
In this article, we developed a multi-component, consensus-driven, and evidence-based eosinophil gradient algorithm to determine the prevalence of eosinophilic and non-eosinophilic phenotypes in the severe asthma population, and whether they can be differentiated by clinical and biomarker variables.
Cluster analysis of inflammatory biomarker expression in the International Severe Asthma Registry (ISAR)
Denton E, et al. J Allergy Clin Immunol Pract 2021; 9(7): 2680 – 2688.e7.
Allergy, eosinophilic inflammation, and epithelial dysregulation have each been implicated in severe asthma pathogenesis, and different inflammatory pathways in severe asthma may be activated to a different extent in different patients. This paper sought out to describe the interrelation between inflammatory biomarker expression in severe asthma in order to characterise the activation of underlying inflammatory pathways.
Potential Severe Asthma Hidden in UK Primary Care
Ryan D, et al. J Allergy Clin Immunol Pract 2021;9(4):1612-1623.e9.
Primary care physicians are often reticent to refer asthma patients to specialist care. The aims of this study were to identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care PSA patients with confirmed severe asthma patients from UK tertiary care.
International severe asthma registry (ISAR): protocol for a global registry
FitzGerald J. M, et al. BMC Med Res Methodol 2020;20(1):212.
Aiming to offer a rich source of real-life data for scientific research to understand and improve disease burden, treatment patterns and outcomes in patients with severe asthma, this paper describes the protocol for the development and management of the multi-disciplinary ISAR initiative.
Characterization of Severe Asthma Worldwide: Data from the International Severe Asthma Registry (ISAR)
Wang E, et al. CHEST 2020;157(4):790-804
To date, clinical characteristics of the international severe asthma population are unknown. This paper describes the demographic and clinical characteristics of patients managed in severe asthma services in the US, Europe, and Asia/Pacific region.
International Severe Asthma Registry: Mission Statement
The ISAR Study Group. CHEST 2020;157(4):805-814
The International Severe Asthma Registry (ISAR) is the first global adult severe asthma registry. It is a joint initiative where national registries (both newly created and pre-existing) retain ownership of their own data but open their borders and share data with ISAR for ethically-approved research purposes. This paper fully describes how ISAR may improve our understanding of severe asthma.
Development of the International Severe Asthma Registry (ISAR): A Modified Delphi Study
Bulathsinhala L, et al. J Allergy Clin Immunol Pract 2019; 7(2): 578-588.e2
Getting 27 experts to agree on anything is impressive! This paper describes the process of reaching consensus on which core variables to collect in ISAR.