Comparative effectiveness of Anti-IL5 and Anti-IgE biologic classes in patients with severe asthma eligible for both

Paul E Pfeffer, Nasloon Ali, Ruth Murray, Charlotte Ulrik, Trung N Tran, Jorge Maspero, Matthew Peters, George C Christoff, Mohsen Sadatsafavi, Carlos A Torres-Duque, Alan Altraja, Lauri Lehtimäki, Nikolaos G Papadopoulos, Sundeep Salvi, Richard W Costello, Breda Cushen, Enrico Heffler, Takashi Iwanaga, Mona Al-Ahmad, Désirée Larenas-LinnemannPiotr Kuna, João A Fonseca, Riyad Al-Lehebi, Chin Kook Rhee, Luis Perez-de-Llano, Diahn-Warng Perng Steve, Bassam Mahboub, Eileen Wang, Celine Goh, Juntao Lyu, Anthony Newell, Marianna Alacqua, Andrey S Belevskiy, Mohit Bhutani, Leif Bjermer, Unnur Bjornsdottir, Arnaud Bourdin, Anna von Bulow, John Busby, Giorgio Walter Canonica, Borja G Cosio, Del Dorscheid, Mariana Muñoz-Esquerre, J Mark FitzGerald, Esther Garcia Gil, Peter G Gibson, Liam G Heaney, Mark Hew, Ole Hilberg, Flavia Hoyte, David J Jackson, Mariko Siyue Koh, Hsin-Kuo Ko Bruce, Jae Ha Lee, Sverre Lehmann, Cláudia Chaves Loureiro, Dóra Lúðvíksdóttir, Andrew N Menzies-Gow, Patrick Mitchell, Andriana I Papaioannou, Todor A Popov, Celeste M Porsbjerg, Laila Salameh, Concetta Sirena, Camille Taillé, Christian Taube, Yuji Tohda, Michael E Wechsler, David Price

8 Citations (Scopus)


BACKGROUND: Patients with severe asthma may present with characteristics representing overlapping phenotypes, making them eligible for more than one class of biologic. Our aim was to describe the profile of adult patients with severe asthma eligible for both anti-IgE and anti-IL5/5R and to compare the effectiveness of both classes of treatment in real life.

METHODS: This was a prospective cohort study that included adult patients with severe asthma from 22 countries enrolled into the International Severe Asthma registry (ISAR) who were eligible for both anti-IgE and anti-IL5/5R. The effectiveness of anti-IgE and anti-IL5/5R was compared in a 1:1 matched cohort. Exacerbation rate was the primary effectiveness endpoint. Secondary endpoints included long-term-oral corticosteroid (LTOCS) use, asthma-related emergency room (ER) attendance and hospital admissions.

RESULTS: In the matched analysis (n=350/group), the mean annualized exacerbation rate decreased by 47.1% in the anti-IL5/5R group and 38.7% in the anti-IgE group. Patients treated with anti-IL5/5R were less likely to experience a future exacerbation (adjusted IRR 0.76; 95% CI 0.64, 0.89; p<0.001) and experienced a greater reduction in mean LTOCS dose than those treated with anti-IgE (37.44% vs 20.55% reduction; p=0.023).) There was some evidence to suggest that patients treated with anti-IL5/5R experienced fewer asthma-related hospitalizations (IRR 0.64; 95% CI 0.38, 1.08), but not ER visits (IRR 0.94, 95% CI 0.61, 1.43).

CONCLUSIONS: In real life, both anti-IgE and anti-IL5/5R improve asthma outcomes in patients eligible for both biologic classes, however anti-IL5/5R was superior in terms of reducing asthma exacerbations and LTOCS use.

Original languageEnglish
Issue number7
Pages (from-to)1934-1948
Number of pages15
Publication statusPublished - Jul 2023


  • Adrenal Cortex Hormones/therapeutic use
  • Anti-Asthmatic Agents
  • Antibodies, Monoclonal, Humanized/therapeutic use
  • Asthma/drug therapy
  • Biological Products/therapeutic use
  • Humans
  • Immunosuppressive Agents/therapeutic use
  • Prospective Studies


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