{
  "abstract": "BACKGROUND: Biologics generally are 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. RESEARCH QUESTION: Does the timing of biologic initiation affect SA outcomes, including remission? STUDY DESIGN AND METHODS: This was a cohort study using data from the International Severe Asthma Registry, the CHRONICLE registry from the United States, and the UK Optimum Patient Care Research Database, together constituting data from 26 countries. The duration to biologic initiation was described using several proxies (eg, duration of asthma, potential SA [PSA], lung function impairment, and frequent exacerbations, all before biologic administration). The associations between these proxies and clinical remission, exacerbations, asthma control, lung function, and oral corticosteroid (OCS) use were assessed. RESULTS: The association analyses included 9,241 patients. Overall, the likelihood of achieving improvement in each outcome after biologic administration decreased with increasing time to biologic initiation. The odds of achieving clinical remission 12 months after biologic initiation were reduced for every 10 years patients had asthma before biologic initiation (0.86 [0.84-0.88], PSA (0.78 [0.63-0.96]), and had lung function impairment (0.24 [0.21-0.28]) and for every 10-g lifetime cumulative OCS dose (0.54 [0.30-0.98]). For every 10 years patients had PSA before biologic initiation, exacerbation rates after biologic initiation were 1.08 (1.03-1.13) times higher, lung function improvement was 2.35% (-3.18% to -1.51%) less, and the odds of having well-controlled or partly controlled asthma were 12% lower (0.88 [0.53-1.47]). INTERPRETATION: Our results show that 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, that is, not reserving biologics for those with long-standing SA, and instead preserving patient lung function and possibly increasing the likelihood of better clinical outcomes with earlier biologic initiation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT03373045; URL: www. CLINICALTRIALS: gov.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 141,
  "authors": [
    {
      "name": "Giorgio Walter Canonica"
    },
    {
      "name": "George Christoff"
    },
    {
      "name": "Ming-Ju Tsai"
    },
    {
      "name": "Trung Tran"
    },
    {
      "name": "John Townend"
    },
    {
      "name": "Ghislaine Scelo"
    },
    {
      "name": "Aaron Beastall"
    },
    {
      "name": "Lakmini Bulathsinhala"
    },
    {
      "name": "John Busby"
    },
    {
      "name": "Andrew Lindsley"
    },
    {
      "name": "Wendy Moore"
    },
    {
      "name": "Reynold Panettieri"
    },
    {
      "name": "Enrico Heffler"
    },
    {
      "name": "Cristina Cardini"
    },
    {
      "name": "Giuseppe Guida"
    },
    {
      "name": "Eileen Wang"
    },
    {
      "name": "Michael Wechsler"
    },
    {
      "name": "Nicholas Chapman"
    },
    {
      "name": "Flavia Hoyte"
    },
    {
      "name": "Rohit Katial"
    },
    {
      "name": "Kanao Otsu"
    },
    {
      "name": "Celeste Porsbjerg"
    },
    {
      "name": "Anne-Sofie Bjerrum"
    },
    {
      "name": "Anna von Bülow"
    },
    {
      "name": "Susanne Hansen"
    },
    {
      "name": "Ole Hilberg"
    },
    {
      "name": "Kjell Erik Julius Håkansson"
    },
    {
      "name": "Marianne Baastrup Søndergaard"
    },
    {
      "name": "Charlotte Suppli Ulrik"
    },
    {
      "name": "Liam Heaney"
    },
    {
      "name": "David Jackson"
    },
    {
      "name": "Pujan Patel"
    },
    {
      "name": "Paul Pfeffer"
    },
    {
      "name": "Dermot Ryan"
    },
    {
      "name": "Piotr Kuna"
    },
    {
      "name": "Celine Bergeron"
    },
    {
      "name": "Shawn Aaron"
    },
    {
      "name": "Shelley Abercromby"
    },
    {
      "name": "Mohit Bhutani"
    },
    {
      "name": "Kenneth Chapman"
    },
    {
      "name": "Andréanne Côté"
    },
    {
      "name": "Beth Davis"
    },
    {
      "name": "Delbert Dorscheid"
    },
    {
      "name": "Leiana Hoshyari"
    },
    {
      "name": "Brianne Philipenko"
    },
    {
      "name": "Mohsen Sadatsafavi"
    },
    {
      "name": "Hana Serajeddini"
    },
    {
      "name": "Désirée Larenas-Linnemann"
    },
    {
      "name": "Borja Cosio"
    },
    {
      "name": "Luis Perez-De-Llano"
    },
    {
      "name": "Carlos Torres-Duque"
    },
    {
      "name": "María José Fernández-Sánchez"
    },
    {
      "name": "Elizabeth Garcia"
    },
    {
      "name": "Fabio Bolívar-Grimaldos"
    },
    {
      "name": "Libardo Jiménez-Maldonado"
    },
    {
      "name": "Diana Jimena Cano-Rosales"
    },
    {
      "name": "Ivan Solarte"
    },
    {
      "name": "Florence Schleich"
    },
    {
      "name": "Renaud Louis"
    },
    {
      "name": "Riyad Al-Lehebi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c3hyf3b8d2s79.bib",
  "cited_by": 0,
  "doi": "10.1016/j.chest.2026.06.076",
  "fulltext_url": null,
  "id": "c3hyf3b8d2s79",
  "issns": [
    "0012-3692",
    "1931-3543"
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  "landing_url": "https://hal.science/hal-05755550v1",
  "language": "en",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
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      "2737|Asthma and respiratory diseases"
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  "pdf_url": "https://journal.chestnet.org/article/S0012-3692(26)06552-9/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-19",
  "publisher": "American College of Chest Physicians",
  "ris": "https://research.draconitic.com/paper/c3hyf3b8d2s79.ris",
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    {
      "first_seen": "2026-10-30T12:17:36Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2737|Asthma and respiratory diseases",
      "subfield": "physiology"
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  "title": "Assessing the impact of earlier initiation of biologics on clinical remission and other outcomes in a global real-life severe asthma cohort from CHRONICLE, ISAR and OPCRD",
  "title_text": "Assessing the impact of earlier initiation of biologics on clinical remission and other outcomes in a global real-life severe asthma cohort from CHRONICLE, ISAR and OPCRD",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:36Z",
  "url": "https://research.draconitic.com/paper/c3hyf3b8d2s79",
  "venue": "Chest",
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}