Presentation (CTI)

OBJECTIVES: A range of biologic therapies, including omalizumab, mepolizumab, benralizumab, dupilumab and tezepelumab, are available for the treatment of severe asthma. However, not all patients achieve adequate disease control with their initial biologic therapy. This study aimed to evaluate the real-world treatment persistence and effectiveness of biologic therapies in patients with severe asthma.
METHODS: We conducted a retrospective cohort study using electronic medical records from multiple centers in Taiwan. Patients with severe asthma who initiated their first biologics between January 2015 and March 2024 were included. Primary outcomes were treatment duration and switching within one year. Asthma prescription patterns in the 180 days prior to biologic initiation were analyzed as indicators of disease severity. Secondary outcomes included surrogate effectiveness, such as emergencies or hospital admissions for acute exacerbations. Baseline characteristics (e.g., age, sex, IgE, eosinophils) were analyzed for their association with prescription patterns and biologic selection.
RESULTS: Among median follow-up of 41.5 months, a total of 2,136 severe asthma patients with a mean age of 42.0 (SD: 24.0) years, 43.5% female and 56.5% male, newly receiving biologics were included. The median of baseline IgE and blood eosinophil counts level were 787.0 (149.0 - 4510.0) IU/mL and 3.5 (1.2 - 7.2) %, respectively. Omalizumab was the most frequently initiated biologic (55.7%), followed by mepolizumab (10.5%). Switching occurred in 3.6 - 3.9% of omalizumab users and 0.9 - 12.5% of mepolizumab users, mostly to benralizumab. ICS-LABA-LAMA + OCS + other mechanism was the most common pre-biologic regimen (29.9%), mainly followed by omalizumab (57.9%). One-year hospitalization rate was 25.2% (median: 4.7 months).
CONCLUSIONS: Omalizumab was the most commonly initiated biologic among patients with severe asthma. Treatment persistence was generally high, and switching rates were low. Future studies are warranted to validate and extend these real-world findings.