Background
Biologic therapy in asthma can be life-changing but change in quality of life is under-represented in the literature.
Aim
Can early improvement in patient reported outcome measures (PROM) predict response to biologic therapy at 12 months?
Methods
A service evaluation of severe asthmatics commencing biologics at the Royal Devon NHS trust between 2019-22.
Health Related Quality of Life (SAQ) and asthma control (ACQ-6) was captured at baseline, 4-8 weeks, 12-28 weeks and 12 months.
Patients were classified as super-responder, responder or non-responder using Delphi ?super-responder? criteria and NICE criteria for biologic response.
Analysis of variance (ANOVA) with Bonferonni post hoc tests were used to determine statistical difference in change from baseline PROM scores between responder groups.
Results
100 patients were included.
Table 1 shows the mean change in PROM scores at 4-8 week and 12-28 weeks.
| 4-8 week | 12-28 week | ||
|
SAQ (0-7) |
All responder | 1.0 | 1.3 |
| Non-responder | -0.1 | -0.5 | |
|
SAQ Global (0-100) |
All responder | 18.4 | 23.7 |
| Non-Responder | 0.9 | -10.0 | |
|
ACQ (0-6) |
All Responder | 1.1 | 1.5 |
| Non-Responder | 0.7 | 0.3 |
At 4-8 weeks and 12-28 weeks, all-responders had greater improvement in SAQ & SAQ-global compared to non-responders (p<0.05).
Improvement in ACQ only achieved significance between all-responders and non-responders at 12-28 weeks (p<0.05).
Sub-analysis of all-responders showed that super-responders had higher SAQ scores than responders or non-responders at 4-8 weeks (p<0.01).
Conclusion
This study confirms the utility of the SAQ and ACQ as core outcome measures in severe asthma capable of early prediction of response, non-response and super-response to biologics.