Association Between a Type 2 Inflammatory Disease Burden Score and Outcomes Among Patients with Asthma

Abstract

Background Although prevalence of co-existing type 2 inflammatory diseases (cT2) in asthma patients has been reported, limited data exist regarding their impact on asthma outcomes. Objective To assess the impact of cT2 burden on asthma outcomes and to evaluate patterns of clustering of cT2 in a real-world setting. Methods From medical records of 4.5 million enrollees in 650 primary care practices in the UK (January 2010–December 2017), patients with ≥1 diagnosis code for asthma at any time pre-index date (date of most recent asthma-related medical encounter) and ≥2 asthma-related prescriptions during the year before index date were categorized into the Global Initiative of Asthma (GINA) guideline severity steps. A cT2 burden score (range 0–9) was assigned based on the total number of co-existing conditions (allergic conjunctivitis, allergic rhinitis, anaphylaxis, eczema/atopic dermatitis, chronic rhinosinusitis, eosinophilic esophagitis, food allergy, nasal polyps, or urticaria) for which patients received a medical diagnosis. Multivariate regression models evaluated associations between cT2 burden score and asthma exacerbations and asthma control. Factor analysis was performed to assess which cT2 comorbidities were correlated and exhibited patterns of clustering. Results Overall, 245,893 patients with asthma were included (mean [SD] age 44.8 [22.1] years; 43.8% male). Between 55% (GINA step 1) and 60% (GINA step 5) of asthma patients had a medical diagnosis for ≥1 other type2dx. Patients with increased cT2 burden were significantly more likely to experience asthma exacerbations and less likely to achieve asthma control. Conclusion Asthma patients with a higher cumulative cT2 burden score were more likely to experience worse asthma outcomes than those without any cT2 (burden score of 0).

A real-life comparison of pulmonary and nasal outcomes in patients with severe asthma and nasal polyposis treated with T2-biologics

“… 4 About 3–10% of asthma patients have severe asthma (SA), 5 defined as insufficient control of asthma under therapy with high-dose inhaled corticosteroids (ICS), long-acting beta2-agonist (LABA), long-acting muscarin-antagonist (LAMA), and additional medication (including oral corticosteroid; OCS) for at least 6 months per year, or by insufficient asthma control when high-intensity treatment is reduced. 5 , 6 , 7 , 9 Approximately 50–70% of the patients have type 2 asthma, 6 , 10 , 11 including eosinophilic and allergic asthma phenotypes. 10 Type 2 inflammation is defined by elevated fractional exhaled nitric oxide (FeNO) equal to or over 20 ppb; and/or blood eosinophils ≥150/μl; and/or elevated total IgE; and/or asthma that is clinically allergen-driven; and/or that requires OCS.…”

“…5 , 6 , 7 , 9 Approximately 50–70% of the patients have type 2 asthma, 6 , 10 , 11 including eosinophilic and allergic asthma phenotypes. 10 Type 2 inflammation is defined by elevated fractional exhaled nitric oxide (FeNO) equal to or over 20 ppb; and/or blood eosinophils ≥150/μl; and/or elevated total IgE; and/or asthma that is clinically allergen-driven; and/or that requires OCS. 2 Clinical effects of therapies with type 2-targeting biologics mepolizumab or reslizumab (anti-IL-5 antibodies), benralizumab (anti-IL-5 Rα antibody), dupilumab (anti-IL-4Rα antibody inhibiting signaling of IL-4 and IL-13), and omalizumab (anti-IgE antibody) have shown efficacy in several placebo-controlled studies in asthma patients.…”

Consensus on the management of united airways disease with type 2 inflammation: a multidisciplinary Delphi study

“…The identification of phenotypes and underlying endotypes is currently the best approach to define UAD and predict the patient’s prognosis [ 1 , 4 , 5 , 33 ]. While the expert panel agreed on the association of several biomarkers with T2 inflammation, it should be noted that, for some biomarkers (i.e., elevated FeNO and total serum IgE), the available evidence mostly reports data in asthma patients [ 9 , 21 , 34 ].…”

Characterisation of the Australian Adult Population Living with Asthma: Severe - Exacerbation Frequency, Long-Term OCS Use and Adverse Effects

“…OCS prescription patterns included the number of scripts administered with and without repeat authorisations for both acute and long-term regimes. Comorbidities of interest were those potentially related to steroid use, 9 type-2 asthma 20 ( Appendix 2 contains a full list of disease codes and free text terms used to define allergies and allergic asthma) or confounders for asthma, including obesity ( Table 1 ; Appendix 3 contains a full list of disease codes and free text terms used to define obesity). The secondary outcome was the association of steroid-related comorbidities following repeated exposure to OCS as previously published ( Table 1 ).…”