Abstract
BackgroundDiscrepancies exist between guidelines and real-life practice in severe asthma. Objectives: To establish profiles for severe asthma patients according to their maintenance therapies and identify unmet needs. Methods2432 French lung specialists and allergists were invited to participate in a severe asthma survey between March and April 2018. Retrospective data were collected using an electronic case report form developed by IQVIA. Results71 respiratory physicians and/or allergists participated in the study, providing data for 736 severe asthma patients. The annual mean rates of hospitalization and exacerbation in the previous year were 0.65 (SD = 0.5) and 2.25 (SD = 1.0), respectively. One hundred one (13.7%) patients were treated with oral steroids; the mean dosage regimen was 16.1 mg per day (SD = 11.2). ICS-LABA-LAMA triple inhaled therapy was reported for 288 patients (39%); 231 patients (31.4%) had one biologic in their maintenance treatment. Among patients hospitalized at least once in the previous year (n = 311), 89 (28.5%) were currently treated with biologics, and 61 (19.6%) with oral steroids. One hundred sixty-six patients with uncontrolled asthma and no current biologic therapy had data for “T2 status”; 78 (47%), 89 (53.6%) and 137 (82.5%) of them had treatment criteria respectively for an anti-IgE, anti-IL5-pathway or anti-IL-4/IL-13 pathway therapy; 22 (13.2%) were ineligible for any current biologic according to biomarkers. ConclusionOur study updated “real-life” therapeutic management data for severe asthma in France in 2018. We highlighted a need for improved patient-phenotyping. This work also gives a striking insight of the position of current and forthcoming biologics.
Highlights
Asthma is a heterogenous disease whose main feature is chronic airway inflammation
Inhaled CorticoSteroids (ICS)-Long Acting Bêta Agonist (LABA)-Long Acting Muscarinic Agonist (LAMA) triple inhaled therapy was reported for 288 patients (39%); 231 patients (31.4%) had one biologic in their maintenance treatment
One hundred sixty-six patients with uncontrolled asthma and no current biologic therapy had data for “T2 status”; 78 (47%), 89 (53.6%) and 137 (82.5%) of them had treatment criteria respectively for an anti-Immunoglobulin E (IgE), anti-Interleukin 5 (IL5)-pathway or anti-IL-4/IL-13 pathway therapy; 22 (13.2%) were ineligible for any current biologic according to biomarkers
Summary
Asthma is a heterogenous disease whose main feature is chronic airway inflammation Novel biologics such as IL5 and IL-4/IL-13 pathway-targeting therapies have made essential the phenotyping of severe asthma, according to GINA guidelines. This strategy aims to drastically decrease annual exacerbation rates and the need for oral steroids, while improving levels of asthma control.1–3These guidelines were mostly evidence based and potentially modulated by the recent ATS/ERS (American Thoracic Society/European Respiratory Society) task force where data robustness was confronted with grading strategies.[4] Though these documents are considered as standard expert references by both patients and clinicians, in certain situations they can be challenged by payers. Discrepancies exist between guidelines and real-life practice in severe asthma
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