Biomarkers do not discriminate severe from severe uncontrolled asthma

Biomarkers are key to understanding asthma phenotypes and may help in distinguishing patient subgroups to guide therapeutic strategies. In the NOVELTY study, markers such as blood eosinophils, fractional exhaled nitric oxide (FeNO), and atopy history did not distinguish severe asthma from severe uncontrolled asthma.

Asthma is a heterogeneous disease characterised by multiple phenotypes. Phenotype-specific markers could be useful in predicting outcomes and therapeutic response to target therapies. In the previous years, research has been done on the identification of valid biomarkers for asthma. With the NOVELTY study (NCT02760329), Dr Bo Ding (AstraZeneca, Sweden) and colleagues have added a considerable amount of biomarker data to the asthma field [1].

The NOVELTY study is a global, prospective study of patients with physician-assigned asthma. The primary objective was to characterise the distribution of biomarkers (Type 2 inflammatory markers) in severe asthma. Patients who had severe asthma or severe uncontrolled asthma at baseline were included. Physician-classified asthma severity was used, with uncontrolled asthma defined as an asthma control test score <20 or ≥1 exacerbation in the past 12 months. Atopy history was also available. The blood biomarkers of interested were eosinophils and FeNO.

Overall, 652 patients had physician-assessed severe asthma at baseline, and 454 (70%) of these met the criteria for uncontrolled asthma (see Figure). The mean age was 54.0 years for severe asthma and 54.1 years for severe uncontrolled asthma. The overall distribution of Type 2 inflammation markers was similar in patients with severe versus severe uncontrolled asthma. Most patients had ≥1 positive marker (86.7% for severe asthma vs 86.3% for severe uncontrolled asthma). Of patients with severe asthma, 45.7% had ≥2 positive markers, compared to 43.8% of patients with uncontrolled severe asthma. Distribution of all 3 markers was also similar between both groups: 11.5% versus 11.7%. Moreover, 13.3% versus 13.7% of patients were not positive for any of the markers.

Figure: Distribution of biomarkers in NOVELTY patients with severe asthma and severe uncontrolled asthma [1]



Taken together, around 86% of patients with severe asthma had some marker of Type 2 inflammation. Overlap of marker positivity was common: high eosinophils, high FeNO, and history of allergy were similar among NOVELTY patients with severe asthma and severe uncontrolled asthma.

1. Ding B, et al. Distribution of biomarkers in severe asthma and severe uncontrolled asthma. Abstract 4214. ERS 2021, 5–8 September.

 

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Posted on 9 November 2021