New Insights in Severe Asthma Treatment: ISAR Research Summary

As the first global adult severe asthma registry, the International Severe Asthma Registry (ISAR) provides the statistical power to study severe asthma epidemiology, clinical management, and outcomes. ISAR has 25 research projects, on ‘what severe asthma looks like’, the ‘appropriate care for severe asthma’, and the ‘effectiveness of biologics’. Its key research outputs include the characterization of severe asthma worldwide, eosinophilic asthma phenotyping, and the steroid-sparing effect of biologics, which continue to change paradigms in severe asthma research. Quality improvement initiatives, such as the embedding of data collection in routine clinical care and interactive asthma care reports, form part of ISAR’s vision for the future.

Real-world biologic use and switch patterns in severe asthma: data from the International Severe Asthma Registry and the US CHRONICLE Study

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?  For more details, you can access the full article

Global Variability in Administrative Approval Prescription Criteria for Biologic Therapy in Severe Asthma

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. Check out this figure to see how you compare to other countries for access to benralizumab. For more details, you can access the full article

Impact of socioeconomic status on adult patients with asthma: a population-based cohort study from UK primary care

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 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

The International Severe Asthma Registry (ISAR) eosinophil phenotype gradient algorithm was applied to a UK primary care cohort that included patients from the Optimum Patient Care Research Database (OPCRD) and the Clinical Practice Research Datalink. The eosinophilic phenotype was predominant across all asthma severities in UK primary care. Patients with most likely eosinophilic asthma tended to have poorer asthma control and greater healthcare resource utilization than those with non-eosinophilic asthma. Asthma eosinophilic phenotyping should become part of routine clinical practice in primary care, since patients with eosinophilic asthma phenotypes may benefit from Type 2 targeted treatments such as inhaled corticosteroids and biologics.

Eosinophilic and Noneosinophilic Asthma: An Expert Consensus Framework to Characterize Phenotypes in a Global Real-Life Severe Asthma Cohort

Phenotypic characteristics of patients with eosinophilic and noneosinophilic asthma are not well characterized in global, real-life severe asthma cohorts. This study developed an eosinophil gradient algorithm using variables readily accessible in real-life and found that the eosinophilic severe asthma phenotype was more prevalent than previously thought. By shedding greater light on treatable traits, the delivery of precision medicine can be made more effective.

Potential Severe Asthma Hidden in UK Primary Care

Severe asthma patients often remain hidden in primary care, leading to suboptimal management of their disease and worsening of symptoms and an increase in overall burden. This study quantified the proportion of these “hidden” patients and described the common characteristics observed. Early identification of these patients and referral to specialist services is key in improving asthma outcomes, and characterizing this population may aid clinicians in recognizing severe asthma in primary care with greater precision.

BRISAR: Cluster Analysis of Inflammatory Biomarker Expression in the International Severe Asthma Registry (ISAR)

As part of a larger endeavor to better characterize the international severe asthma population, this study looked to describe the differential expression of the various cellular pathways involved in the pathogenesis of this disease. Patients were evaluated by their levels of key biomarkers (pre-biologic initiation) and a high degree of overlap was observed. Furthermore, distinct patient clusters with associated clinical characteristics were identified. 

The findings of this study enable severe asthma phenotypes to be easily distinguished, which may aid in the delivery of precision medicine. Beyond that, it suggests that rather than relying on simple biomarker positivity, a more comprehensive approach – rather than relying on simple biomarker positivity – may be needed to identify the best therapy for patients.

ISAR: Protocol for a Global Registry

Due to the heterogeneity of the severe asthma population, severe asthma exerts a disproportionate burden on patients and healthcare worldwide. To aid in this endeavour, ISAR aims to describe the protocol for registry development and management, the rationale behind each step, and the potential benefits of ISAR to the adult severe asthma population. 

ISAR: Mission Statement 

ISAR aims to improve the care of severe asthma patients by combining existing knowledge with new research. By examining real-world data on the efficacy and safety of different treatment options, we hope to make a positive impact on patient care. Check out our mission statement to learn more about what we hope to accomplish.