Randomised Controlled Trials in Severe Asthma: Selection by Phenotype or Stereotype

  1. Thomas Brown1,3,
  2. Thomas Jones1,3,
  3. Kerry Gove2,
  4. Clair Barber2,
  5. Scott Elliott1,
  6. Anoop Chauhan1 and
  7. Peter Howarth2
  8. on behalf of the Wessex Severe Asthma Cohort team: L Aitkin, S Babu, P Dennison, R Djukanovic, C Grainge, L Hewitt, N Jayasekera, R Kurukulaaratchy, S Kerley, L Lau, D Laws, J Owen, E Ray, D Reynish, H Rupani and O Scullion-Win
  1. 1Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, Portsmouth
  2. 2Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital and NIHR Southampton Biomedical Research Centre, Southampton, UK
  3. 3Authors contributed equally
  1. Dr Thomas Brown, Consultant Respiratory Physician, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, PO63LY. E-mail: thomas.brown{at}porthosp.nhs.uk

Abstract

Background: Previous publications have highlighted the disparity between research trial populations and clinical practise but it is not established how this relates to randomised controlled trials (RCTs) of phenotype targeted biological therapies in severe asthma.

Methods: Detailed characterisation data for 342 severe asthma patients within the Wessex Severe Asthma Cohort (WSAC) was compared against comprehensive trial eligibility criteria for published phase IIB and III RCTs evaluating biological therapies in severe asthma since 2000.

Results: 37 RCTs evaluating 20 biological therapies were identified. Only 9.8% (median; range 3.5%–17.5%) of severe asthma patients would have been eligible for enrolment in the phase III trials. Stipulations for airflow obstruction, bronchodilator reversibility and smoking history exclude significant numbers of patients. 78.9% (median; range 73.2%–86.6%) of patients with severe eosinophilic asthma would have been excluded from participation in the phase III licensing trials of IL-5/5R targeted therapies.

Conclusion: Despite including only well characterised and optimally treated severe asthmatics under specialist care within the Wessex Severe Asthma Cohort study, the vast majority were excluded from trial participation by criteria designed to re-confirm diagnostic labels rather than by biomarker criteria that predict the characteristic addressed by the treatment.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Brown reports personal fees from Teva , personal fees from Chiesi Farmaceutici, non-financial support from AstraZeneca, personal fees from Novartis, personal fees from Napp, outside the submitted work.

Conflict of interest: Dr. Jones reports non-financial support from Teva , personal fees and non-financial support from Chiesi Farmaceutici, outside the submitted work.

Conflict of interest: Ms. Gove has nothing to disclose.

Conflict of interest: Ms. Barber has nothing to disclose.

Conflict of interest: Mr. Elliott has nothing to disclose.

Conflict of interest: Prof. Chauhan reports personal fees and non-financial support from Teva , non-financial support from Boehringer Ingelheim, personal fees from AstraZeneca, outside the submitted work.

Conflict of interest: Prof. Howarth reports grants from Medical Research Council, during the conduct of the study; other from GlaxoSmithKlein, outside the submitted work.

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