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

@article{canonica2026assessing,
  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}},
  author = {Giorgio Walter Canonica and George Christoff and Ming-Ju Tsai and Trung Tran and John Townend and Ghislaine Scelo and Aaron Beastall and Lakmini Bulathsinhala and John Busby and Andrew Lindsley and Wendy Moore and Reynold Panettieri and Enrico Heffler and Cristina Cardini and Giuseppe Guida and Eileen Wang and Michael Wechsler and Nicholas Chapman and Flavia Hoyte and Rohit Katial and Kanao Otsu and Celeste Porsbjerg and Anne-Sofie Bjerrum and Anna von Bülow and Susanne Hansen and Ole Hilberg and Kjell Erik Julius Håkansson and Marianne Baastrup Søndergaard and Charlotte Suppli Ulrik and Liam Heaney and David Jackson and Pujan Patel and Paul Pfeffer and Dermot Ryan and Piotr Kuna and Celine Bergeron and Shawn Aaron and Shelley Abercromby and Mohit Bhutani and Kenneth Chapman and Andréanne Côté and Beth Davis and Delbert Dorscheid and Leiana Hoshyari and Brianne Philipenko and Mohsen Sadatsafavi and Hana Serajeddini and Désirée Larenas-Linnemann and Borja Cosio and Luis Perez-De-Llano and Carlos Torres-Duque and María José Fernández-Sánchez and Elizabeth Garcia and Fabio Bolívar-Grimaldos and Libardo Jiménez-Maldonado and Diana Jimena Cano-Rosales and Ivan Solarte and Florence Schleich and Renaud Louis and Riyad Al-Lehebi},
  journal = {Chest},
  year = {2026},
  month = sep,
  doi = {10.1016/j.chest.2026.06.076},
  url = {https://hal.science/hal-05755550v1},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - 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
AU  - Giorgio Walter Canonica
AU  - George Christoff
AU  - Ming-Ju Tsai
AU  - Trung Tran
AU  - John Townend
AU  - Ghislaine Scelo
AU  - Aaron Beastall
AU  - Lakmini Bulathsinhala
AU  - John Busby
AU  - Andrew Lindsley
AU  - Wendy Moore
AU  - Reynold Panettieri
AU  - Enrico Heffler
AU  - Cristina Cardini
AU  - Giuseppe Guida
AU  - Eileen Wang
AU  - Michael Wechsler
AU  - Nicholas Chapman
AU  - Flavia Hoyte
AU  - Rohit Katial
AU  - Kanao Otsu
AU  - Celeste Porsbjerg
AU  - Anne-Sofie Bjerrum
AU  - Anna von Bülow
AU  - Susanne Hansen
AU  - Ole Hilberg
AU  - Kjell Erik Julius Håkansson
AU  - Marianne Baastrup Søndergaard
AU  - Charlotte Suppli Ulrik
AU  - Liam Heaney
AU  - David Jackson
AU  - Pujan Patel
AU  - Paul Pfeffer
AU  - Dermot Ryan
AU  - Piotr Kuna
AU  - Celine Bergeron
AU  - Shawn Aaron
AU  - Shelley Abercromby
AU  - Mohit Bhutani
AU  - Kenneth Chapman
AU  - Andréanne Côté
AU  - Beth Davis
AU  - Delbert Dorscheid
AU  - Leiana Hoshyari
AU  - Brianne Philipenko
AU  - Mohsen Sadatsafavi
AU  - Hana Serajeddini
AU  - Désirée Larenas-Linnemann
AU  - Borja Cosio
AU  - Luis Perez-De-Llano
AU  - Carlos Torres-Duque
AU  - María José Fernández-Sánchez
AU  - Elizabeth Garcia
AU  - Fabio Bolívar-Grimaldos
AU  - Libardo Jiménez-Maldonado
AU  - Diana Jimena Cano-Rosales
AU  - Ivan Solarte
AU  - Florence Schleich
AU  - Renaud Louis
AU  - Riyad Al-Lehebi
PY  - 2026
DA  - 2026/09/19
JO  - Chest
DO  - 10.1016/j.chest.2026.06.076
UR  - https://hal.science/hal-05755550v1
AB  - 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.
SN  - 0012-3692
SN  - 1931-3543
ER  -