Heterogeneity in the use of biologics for severe asthma in Europe: a SHARP ERS study

Introduction: Our study aims to analyze and describe the use of biologics for treating severe asthma in Europe. Materials and methods: The SHARP clinical research collaboration performed a 3-step survey about the use of biologics in severe asthma across Europe. Five geographically distant countries defined questions, focusing on 7 endpoints related to biologics: availability and financial issues, prescription and administration modalities, inclusion criteria, continuation criteria, switching biologics, combining biologics, and evaluation of corticosteroid toxicity. The survey was then sent to the SHARP National Leads of 28 European countries. Finally, specific questions were submitted to 263 asthma experts selected by national societies. Results: Availability of biologics varied between countries, with 17 countries/28 having all 5 existing biologics. Authorized prescribers (pulmonologists alone versus other specialists) also differed. In-hospital administration was the preferred deliverance modality. While exacerbation rate was used as an inclusion criterion in all countries, FEV1 value was used in 46% of countries. Blood eosinophil levels were an inclusion criterion in all countries for IL5- and IL4/IL13- targeted medications, however with different thresholds. There were no formally established criteria guiding the continuation of biologics. The reduction in exacerbations represented the most important benchmark, followed by the improvement in scores related to asthma control and quality of life. 191/263 (70%) of surveyed clinicians assessed their patients for corticosteroid-induced toxicity. Conclusion: Our study reveals considerable heterogeneity in the use of asthma biologics across Europe.