A comparison of treatment response to biologics in asthma-COPD overlap and pure asthma: Findings from the PRISM study

Background: Despite the increasing use of biologics in severe asthma, there is limited research on their use in asthma-chronic obstructive pulmonary disease overlap (ACO). We compared real-world treatment responses to biologics in ACO and asthma.Methods: We conducted a multicenter, retrospective, cohort study using data from the Precision Medicine Intervention in Severe Asthma (PRISM). ACO was defined as post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.7 and a smoking history of >10 pack-years. Physicians selected biologics (omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab) based on each United States Food & Drug Administration (FDA) approval criteria.Results: After six-month treatment with biologics, both patients with ACO (N = 13) and asthma (N = 81) showed positive responses in FEV1 (10.69 +/- 17.17 vs. 11.25 +/- 12.87 %, P = 0.652), Asthma Control Test score (3.33 +/- 5.47 vs. 5.39 +/- 5.42, P = 0.290), oral corticosteroid use (-117.50 +/- 94.38 vs. -115.06 +/- 456.85 mg, P = 0.688), fractional exhaled nitric oxide levels (-18.62 +/- 24.68 vs. -14.66 +/- 45.35 ppb, P = 0.415), sputum eosinophils (-3.40 +/- 10.60 vs. -14.48 +/- 24.01 %, P = 0.065), blood eosinophils (-36.47 +/- 517.02 vs. -363.22 +/- 1294.59, P = 0.013), and exacerbation frequency (-3.07 +/- 4.42 vs. -3.19 +/- 5.11, P = 0.943). The odds ratio for exacerbation and time-to-first exacerbation showed no significant difference after full adjustments, and subgroup analysis according to biologic type was also showed similar results.Conclusions: Biologics treatment response patterns in patients with ACO and asthma were comparable, suggesting that biologics should be actively considered for ACO patients as well.