Authors
Giorgio Walter Canonica, George C Christoff, Ming-Ju Tsai, Trung N Tran, John Townend, Ghislaine Scelo, Aaron Beastall, Lakmini Bulathsinhala, John Busby, Andrew W Lindsley, Wendy C Moore, Reynold A Panettieri, Enrico Heffler, Cristina Cardini, Giuseppe Guida, Eileen Wang, Michael E Wechsler, Nicholas Chapman, Flavia Hoyte, Rohit K Katial, Kanao Otsu, Celeste M Porsbjerg, Anne-Sofie Bjerrum, Anna von Bülow, Susanne Hansen, Ole Hilberg, Kjell Erik Julius Håkansson, Marianne Baastrup Søndergaard, Charlotte Suppli Ulrik, Liam G Heaney, David J Jackson, Pujan H Patel, Paul E Pfeffer, Dermot Ryan, Piotr Kuna, Celine Bergeron, Shawn D Aaron, Shelley Abercromby, Mohit Bhutani, Kenneth R Chapman, Andréanne Côté, Beth E Davis, Delbert R Dorscheid, Leiana Hoshyari, Brianne Philipenko, Mohsen Sadatsafavi, Hana Serajeddini, Désirée Larenas-Linnemann, Borja G Cosio, Luis Perez-de-Llano, Carlos A Torres-Duque, María José Fernández-Sánchez, Elizabeth Garcia, Fabio Bolívar-Grimaldos, Libardo Jiménez-Maldonado, Diana Jimena Cano-Rosales, Ivan Solarte, Florence Schleich, Renaud Louis, Riyad Al-Lehebi, Adeeb A Bulkhi, Yahya Habis, Mona Al-Ahmad, Bassam Mahboub, Laila Salameh, Paulo Márcio Pitrez, Takashi Iwanaga, Soichiro Hozawa, Hisako Matsumoto, Tatsuya Nagano, Tomoko Tajiri, João A Fonseca, Ana Alves da Silva, Cláudia Chaves Loureiro, Hadassa Cristhina de Azevedo Soares Dos Santos, Nikolaos G Papadopoulos, Konstantinos Kostikas, Mina Gaga, Athena Gogali, Maria Kallieri, Stelios Loukides, Michael Makris, Maria Ntakoula, Andriana I Papaioannou, Giannis Paraskevopoulos, Fotios Psarros, Diahn-Warng Perng, Yi-Han Hsiao, Pin-Kuei Fu, Chau-Chyun Sheu, Bernt Bøgvald Aarli, Todor A Popov, Mariko Siyue Koh, Mei Fong Liew, Pee Hwee Pang, Tze Lee Tan, Tunn Ren Tay, Chin Kook Rhee, Jorge Máspero, Ledit R F Ardusso, María Eugenia Franchi, Martin Sivori, Ana María Stok, Anahí Yañez, Njira Lugogo, Arjun Mohan, Patrick D Mitchell, Alan Altraja, Sundeep Salvi, Richard W Costello, Eve J Denton, Mark Hew, Christine Jenkins, David Langton, Peter G Middleton, Matthew J Peters, Lauri Lehtimäki, Arnaud Bourdin, Camille Taillé, Christian Taube, Zsuzsanna Csoma, Dóra Lúdvíksdóttir, Job F M van Boven, James Fingleton, Helena Emery, Graham Lough, Valeria Perugini, Leif Bjermer, Diego J Maselli, Roy Alton Pleasants, Christopher S Ambrose, Benjamin Emmanuel, Cathy Emmas, Andrew N Menzies-Gow, Amit D Parulekar, Victoria Carter, Nevaashni Eleangovan, Ruth B Murray, Chris A Price, John D Blakey, David B Price, ISAR GLEAM Working Group
Published in
Chest. Sep 09, 2026. Epub Sep 09, 2026.
Abstract
Biologics are generally reserved for severe asthma (SA) after standard treatments have failed. Their recommendation is based on randomized controlled trials, designed to assess efficacy but not the optimal timing for biologic initiation.
Does the timing of biologic initiation affect SA outcomes, including remission?
This was a cohort study using data from the International Severe Asthma Registry, the CHRONICLE US SA registry, and the UK Optimum Patient Care Research Database, together comprising data from 26 countries. The duration of time to biologic initiation was described using several proxies (e.g., duration of asthma, potential SA [PSA], lung function impairment, and frequent exacerbations, all pre-biologic). The associations between these proxies and clinical remission, exacerbations, asthma control, lung function, and oral corticosteroid (OCS) use were assessed.
9,241 patients were included in the association analyses. Overall, the likelihood of achieving improvement in each outcome post-biologic decreased with increasing time-to-biologic-initiation. The odds of achieving clinical remission 12-months post-biologic initiation were reduced for every 10 years patients had asthma pre-biologic (0.86 [0.84, 0.88], PSA (0.78 [0.63, 0.96]), and lung function impairment (0.24 [ 0.21, 0.28]) and for every 10 grams lifetime cumulative OCS dose (0.54 [0.30, 0.98]). For every 10-years patients had PSA pre-biologic, post-biologic exacerbation rates were 1.08 [1.03, 1.13] times higher, lung function improvement was 2.35% [-3.18, -1.51] less, and the odds of having well- or partly-controlled asthma was 12% lower (0.88 [0.53, 1.47]).
Earlier initiation of biologics in individuals with SA is associated with better clinical outcomes, suggesting the need to modify approaches to asthma management from a 'reserve' to a 'preserve' approach: i.e., not reserving biologics for those with long-standing SA, instead preserving patients' lung function and possibly increasing the likelihood of better clinical outcomes with earlier biologic initiation.
CHRONICLE - ClinicalTrials.gov identifier: NCT03373045.
PMID:
42716466
Bibliographic data and abstract were imported from PubMed on 10 Sep 2026.
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