Switching or Stopping Biologic Therapy in Severe Asthma Yields Worse Outcomes

Woman coughing
Woman coughing
The CLEAR study compared clinical outcomes and health resource usage in patients with severe asthma who continued, switched, or stopped their biologic treatment.

Patients with severe asthma who switch or stop biologic therapy have worse clinical outcomes and use more health care resources those who continue the same biologic treatment, according to research findings presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting, held October 16 to 19, in Nashville, Tennessee.

Researchers compared patients with severe asthma who continued, switched, or stopped biologic treatment by evaluating clinical outcomes and health care resource utilization observed in the CLEAR Study, an observational, multicenter including 1859 adults from 23 countries who were part of the International Severe Asthma Registry from December 2015 through August 2021.

The clear study analyzed patient data collected for at least 12 months prior to and at least 6 months following biologic therapy initiation. Patients were stratified according to therapy usage: continued (used first biologic at least 6 months following therapy initiation), switched (discontinued first biologic after less than 6 months and received a different biologic), and stopped (discontinued first biologic after less than 6 months and did not receive another biologic). Propensity score matching was utilized for all residual confounders.

The researchers found that 60.0% (1116) of participants continued, 25.5% (474) switched, and 14.5% (269) stopped biologic treatment. Patients who switched or stopped therapy during the 6 months following initiation had a greater risk of exacerbation vs patients who continued therapy (adjusted incident rate ratio [aIRR]: switched, 1.80 [95% CI, 1.48-2.19]; stopped, 1.50 [95% CI, 1.16-1.95]), and these patients were more likely to have uncontrolled asthma (adjusted odds ratio [aOR]: switched, 3.64 [95% CI, 2.49-5.30]; stopped, 2.61 [95% CI, 1.68-4.08]). 

Researchers observed patients who switched vs patients who continued therapy were less likely to have long-term oral corticosteroid dose reduction (adjusted ß-coefficient -2.61; 95% CI, -4.38 to -0.84) and had higher levels of hospitalization (aIRR, 1.85; 95% CI, 1.19-2.87) and emergency room visits (aIRR, 1.85; 95% CI, 1.24-2.77). Overall, around 40% of patients were found to have stopped or switched biologic therapy.

Because patients who continued biologic therapy achieved better clinical outcomes than those who stopped or switched, researchers concluded that their study underscored “the importance of selecting the right initial biologic for continual therapy.” They further noted that “Biologics targeting multiple inflammatory pathways may address the limitations of phenotyping, which may reduce therapy stopping or switching.”

Disclosure: 1 study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Ali N, Chen S, Tran TN, et al. Clinical outcomes and emergency health care utilization in patients with severe asthma who continued, switched, or stopped biologic therapy: Results from the CLEAR Study. Presented at: CHEST 2022 Annual Meeting; October 16 to 19, 2022; Nashville, TN.

This article originally appeared on Pulmonology Advisor