Biologic effectiveness increases with earlier biologic initiation after severe asthma onset

Background Patients with long-standing, uncontrolled, severe asthma can develop airway fibrosis and remodeling due to chronic inflammation, causing irreversible pulmonary damage.Objective This analysis evaluated the effect of the time from severe asthma onset to initiation of a biologic on treatment effectiveness in US patients with subspecialist-treated severe asthma.Methods CHRONICLE (ClinicalTrials.gov identifier NCT03373045) was an observational study of US adults with subspecialist-treated severe asthma who were receiving biologics or maintenance systemic corticosteroids or had persistently uncontrolled asthma despite high-dose inhaled corticosteroids and additional controllers. Annualized asthma exacerbation rates in the 12 months before and 12 months after initiation of biologic treatment were compared. Factors with a univariate association (P Results This analysis included 244 patients enrolled between February 2018 and February 2024 who initiated biologic treatment and had complete data. Exacerbation rates decreased by 59% from the pre-biologic initiation period to the post-biologic initiation period. Multivariable analyses demonstrated a significant association between the rate of exacerbation during treatment and time from severe asthma onset to initiation of treatment with a biologic (rate coefficient = 1.04 [95% CI = 1.02-1.07]; P P P = .009).Conclusion With adjustment for factors including prior exacerbations and race, a shorter time from severe asthma onset to initiation of a biologic was associated with a lower rate of exacerbation during treatment and increased effectiveness of treatment with a biologic.