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Prevalence, T2-biomarkers and cost of severe asthma in the era of biologics: The BRAVO-1 study

Domingo C1, 2, Sicras-Mainar A3, Sicras-Navarro A3, Sogo A1,3, Mirapeix RM4, Engroba C5

1Pulmonary Service, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
2Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola, Barcelona, Spain
3Atrys Health-HEOR, Barcelona, Spain
4Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), Cerdanyola, Barcelona, Spain
5Department of Market Acces, Sanofi, Barcelona, Spain

J Investig Allergol Clin Immunol 2024; Vol. 34(2)
doi: 10.18176/jiaci.0871

Background: The last decade has seen a new era of classifications of asthma pathophysiology which have changed the treatment options available.
Objectives: To update the figures of prevalence of T2 asthma, comorbidities, biomarker characterization and costs of severe asthma in patients≥12-years-old adapted to this new situation.
Methods: Retroprospective, observational, nationwide study using a top-down approach. Data were obtained from the BIG-PAC®, an electronic medical record database of 1.7 million patients in Spain. Patients≥12-years-old who had received medical care during the period 2016-2017 and diagnosed with asthma at least one year prior to the index date were included and followed for one year.
Results: Prevalence of asthma was 5.5%. Of these patients, asthma was severe in 3.031 (7.7%), 81.2% of whom presented T2 asthma. Among severe asthma patients, 64·1% were uncontrolled, 31.2% were Oral corticosteroids-dependent (37% in the uncontrolled severe asthma group) and only 3.8% were on biologics. The most common T2 comorbidities were allergic rhinitis (66·1%), atopic dermatitis (29·1%) and chronic rhinositis with nasal polyps (14.6%). Mortality rates in the total and the uncontrolled severe asthma groups were 4.2% and 5.5% respectively. The total annual costs per patient with severe asthma were 5.890€ (uncontrolled) and 2.841€ (controlled).
Conclusions: In the era of biologics, most severe asthma patients present T2 asthma. Despite the availability of new treatments, the rates of uncontrolled and oral corticosteroids-dependent patients with severe asthma remain high, but biologics still underused. The costs of uncontrolled severe asthma are twice as high as those of controlled severe asthma.

Key words: Asthma prevalence, Asthma comorbidities, Asthma costs, Severe asthma, Type 2 asthma, Uncontrolled asthma