Evidence of efficacy of biologics in smokers with severe asthma in the SHARP CRC registry

<bold>Background:</bold> Real-world responses to biologics were assessed by cigarette smoking exposure. <bold>Methods:</bold> Clinical and functional data from 3,689 severe asthmatics in the ERS SHARP (Severe Heterogeneous Asthma Research-Patient Centred) registry were analyzed using the OMOP Common Data Model at baseline and after 1-year of treatment with biologics. <bold>Results:</bold> Among 2,282 never smokers, 505 ex-smokers (<10 pack-years [py]), 766 (≥10 py), and 136 current smokers, respectively, symptom control (ACT≥20/ACQ≤1.5) improved (+220%, +215%, +200%), frequent exacerbations (>2/year) decreased (-67%, -65%, -61%), AQLQ improved (+18%, +23%, +118%), and FEV1 pre-BD (%pred) increased (+10%, +9%, +6%) with no significant differences vs. never smokers, except for AQLQ for which current smokers experienced greatest improvement (Table 1). Survey of physicians showed that 25% oppose prescription of biologics to current smokers and >50% were dissatisfied with current treatment guidelines. <bold>Conclusion:</bold> Former/current smokers respond as well as never smokers to biologics, with AQLQ improving most in current smokers. Management disparities identified across Europe need for inclusive, evidence-based guidelines. <bold>Funding</bold> Unrestricted core funding by pharmaceutical SHARP CRC stakeholders. <table-wrap><object-id>erj;66/suppl_69/OA2210/TB1</object-id><object-id>T1</object-id><object-id>TB1</object-id><caption> Table1: Four-domain response (%change) by smoking groups 1 yr after starting biologics </caption><table><colgroup><col></col><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td>Percent Change</td><td> never smokers N=2282 </td><td> ex-smokers <10PY N=505 </td><td> ex-smokers ≥10PY N=766 </td><td> current smokers N=136 </td></tr><tr><td>Controlled^a</td><td>+218.8</td><td>+220.0</td><td>+215.4</td><td>+200.0</td></tr><tr><td>≥2 exacerbations</td><td>-68.6</td><td>-66.7</td><td>-64.7</td><td>-61.3</td></tr><tr><td>AQLQ</td><td>+19.5</td><td>+18.4</td><td>+23.2</td><td><bold>+117.8</bold></td></tr><tr><td>FEV1%pred</td><td>+10.6</td><td>10.1</td><td>+9.0</td><td>6.3</td></tr></tbody></table></table-wrap> ^aControl is defined by ACT≥20 and/or ACQ≤1.5 and shown as percentage of % change vs. never smokers