Pre-biologic disease trajectories are associated with morbidity burden and biologic treatment response in severe asthma

TY - JOUR

T1 - Pre-biologic disease trajectories are associated with morbidity burden and biologic treatment response in severe asthma

AU - Soendergaard, Marianne Baastrup

AU - Hjortdahl, Frederikke

AU - Hansen, Susanne

AU - Bjerrum, Anne-Sofie

AU - von Bülow, Anna

AU - Hilberg, Ole

AU - Bonnesen Bertelsen, Barbara

AU - Johnsen, Claus Rikard

AU - Lock-Johansson, Sofie

AU - Vijdea, Roxana

AU - Rasmussen, Linda Makowska

AU - Schmid, Johannes Martin

AU - Ulrik, Charlotte Suppli

AU - Porsbjerg, Celeste

AU - Håkansson, Kjell Erik Julius

PY - 2025/4

Y1 - 2025/4

N2 - Background Biologics can induce remission in some patients with severe asthma; however, little is known about pre-biologic disease trajectories and their association with outcomes from biological treatment. We aimed to identify long-term trajectories of disease progression in patients initiating biologics and investigate trajectory associations with disease burden and impact on biologic therapy efficacy. Methods Patients in the Danish Severe Asthma Register initiating biologic therapy between 2016 and 2022 were included and followed retrospectively in prescription databases starting 1995. We performed sequence analysis for inhaled corticosteroid treatment intensity over time combined with unsupervised trajectory clustering. Results In total, 755 patients were included and three pre-biologic disease trajectories were identified: “Chronic severe asthma” (26%), “Gradual onset severe asthma” (35%) and “Recent, sudden onset severe asthma” (39%). “Chronic severe asthma” patients were older, had the longest disease duration (35 years), the most impaired pulmonary function, the highest comorbidity prevalence and the lowest employment rate. “Recent, sudden onset severe asthma” patients were younger, had shorter disease duration (5 years), more tobacco exposure and the least impaired lung function. “Gradual onset severe asthma” patients had an intermediate burden of disease. The “Chronic severe asthma” cluster demonstrated the lowest prevalence of remission (17%) compared to the “Gradual onset severe asthma” (29%) and “Recent, sudden onset severe asthma” (32%) clusters. Conclusions Three pre-biologic disease trajectories were identified, with increased disease duration and activity associating with asthma and comorbidity burden. Early intervention may be key to prevent irreversible adverse outcomes for patients with severe asthma.

AB - Background Biologics can induce remission in some patients with severe asthma; however, little is known about pre-biologic disease trajectories and their association with outcomes from biological treatment. We aimed to identify long-term trajectories of disease progression in patients initiating biologics and investigate trajectory associations with disease burden and impact on biologic therapy efficacy. Methods Patients in the Danish Severe Asthma Register initiating biologic therapy between 2016 and 2022 were included and followed retrospectively in prescription databases starting 1995. We performed sequence analysis for inhaled corticosteroid treatment intensity over time combined with unsupervised trajectory clustering. Results In total, 755 patients were included and three pre-biologic disease trajectories were identified: “Chronic severe asthma” (26%), “Gradual onset severe asthma” (35%) and “Recent, sudden onset severe asthma” (39%). “Chronic severe asthma” patients were older, had the longest disease duration (35 years), the most impaired pulmonary function, the highest comorbidity prevalence and the lowest employment rate. “Recent, sudden onset severe asthma” patients were younger, had shorter disease duration (5 years), more tobacco exposure and the least impaired lung function. “Gradual onset severe asthma” patients had an intermediate burden of disease. The “Chronic severe asthma” cluster demonstrated the lowest prevalence of remission (17%) compared to the “Gradual onset severe asthma” (29%) and “Recent, sudden onset severe asthma” (32%) clusters. Conclusions Three pre-biologic disease trajectories were identified, with increased disease duration and activity associating with asthma and comorbidity burden. Early intervention may be key to prevent irreversible adverse outcomes for patients with severe asthma.

UR - https://www.scopus.com/pages/publications/105001970862

U2 - 10.1183/13993003.01497-2024

DO - 10.1183/13993003.01497-2024

M3 - Journal article

C2 - 39788633

SN - 0903-1936

VL - 65

JO - The European respiratory journal

JF - The European respiratory journal

IS - 4

M1 - 2401497

ER -