Impact of Initiating Biologics in Patients With Severe Asthma on Long-Term Oral Corticosteroids or Frequent Rescue Steroids (GLITTER): Data From the International Severe Asthma Registry

Wenjia Chen, Trung N Tran, Mohsen Sadatsafavi, Ruth Murray, Nigel Chong Boon Wong, Nasloon Ali, Con Ariti, Lakmini Bulathsinhala, Esther Garcia Gil, J Mark FitzGerald, Marianna Alacqua, Mona Al-Ahmad, Alan Altraja, Riyad Al-Lehebi, Mohit Bhutani, Leif Bjermer, Anne-Sofie Bjerrum, Arnaud Bourdin, Anna von Bülow, John BusbyGiorgio Walter Canonica, Victoria Carter, George C Christoff, Borja G Cosio, Richard W Costello, João A Fonseca, Peter G Gibson, Kwang-Ha Yoo, Liam G Heaney, Enrico Heffler, Mark Hew, Ole Hilberg, Flavia Hoyte, Takashi Iwanaga, David J Jackson, Rupert C Jones, Mariko Siyue Koh, Piotr Kuna, Désirée Larenas-Linnemann, Sverre Lehmann, Lauri Lehtimäki, Juntao Lyu, Bassam Mahboub, Jorge Maspero, Andrew N Menzies-Gow, Anthony Newell, Concetta Sirena, Nikolaos G Papadopoulos, Andriana I Papaioannou, Luis Perez-de-Llano, Diahn-Warng Perng Steve, Matthew Peters, Paul E Pfeffer, Celeste M Porsbjerg, Todor A Popov, Chin Kook Rhee, Sundeep Salvi, Camille Taillé, Christian Taube, Carlos A Torres-Duque, Charlotte Ulrik, Seung-Won Ra, Eileen Wang, Michael E Wechsler, David B Price*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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BACKGROUND: Effectiveness of biologics has neither been established in patients with high oral corticosteroid exposure (HOCS) nor been compared with effectiveness of continuing with HOCS alone.

OBJECTIVE: To examine the effectiveness of initiating biologics in a large, real-world cohort of adult patients with severe asthma and HOCS.

METHODS: This was a propensity score-matched, prospective cohort study using data from the International Severe Asthma Registry. Between January 2015 and February 2021, patients with severe asthma and HOCS (long-term OCSs for ≥1 year or ≥4 courses of rescue OCSs within a 12-month period) were identified. Biologic initiators were identified and, using propensity scores, matched 1:1 with noninitiators. The impact of biologic initiation on asthma outcomes was assessed using generalized linear models.

RESULTS: We identified 996 matched pairs of patients. Both groups improved over the 12-month follow-up period, but improvement was greater for biologic initiators. Biologic initiation was associated with a 72.9% reduction in the average number of exacerbations per year versus noninitiators (0.64 vs 2.06; rate ratio, 0.27 [95% CI, 0.10-0.71]). Biologic initiators were 2.2 times more likely than noninitiators to take a daily long-term OCS dose of less than 5 mg (risk probability, 49.6% vs 22.5%; P = .002) and had a lower risk of asthma-related emergency department visits (relative risk, 0.35 [95% CI, 0.21-0.58]; rate ratio, 0.26 [0.14-0.48]) and hospitalizations (relative risk, 0.31 [95% CI, 0.18-0.52]; rate ratio, 0.25 [0.13-0.48]).

CONCLUSIONS: In a real-world setting, including patients with severe asthma and HOCS from 19 countries, and within an environment of clinical improvement, initiation of biologics was associated with further improvements across multiple asthma outcomes, including exacerbation rate, OCS exposure, and health care resource utilization.

Original languageEnglish
JournalThe journal of allergy and clinical immunology. In practice
Issue number9
Pages (from-to)2732-2747
Publication statusPublished - Sept 2023


  • Biologics
  • Effectiveness
  • ISAR
  • Oral corticosteroids
  • Real life


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