Indirect comparison of bronchial thermoplasty versus omalizumab for uncontrolled severe asthma

Research output: Contribution to journalArticlepeer-review

  • External authors:
  • Michael R Simmonds
  • Michael J Cangelosi
  • Dominic P Tilden
  • Suzanne Cottrell
  • Narinder S Shargill

Abstract

OBJECTIVE: Bronchial thermoplasty (BT) as an add-on therapy for uncontrolled severe asthma is an alternative to biologic therapies like omalizumab (OM). We conducted an indirect treatment comparison (ITC) to appraise comparative effectiveness of BT and OM.

METHODS: A systematic literature review identified relevant randomized controlled trials. The ITC followed accepted methodology.

RESULTS: The ITC comprised a sham-controlled trial of BT (AIR2) and two placebo-controlled trials of OM (INNOVATE; EXTRA). Comparing the BT post-treatment period to ongoing treatment with OM, showed no significant differences in the rate ratios (RRs) for severe exacerbations (RR of BT versus OM = 0.91 [95% CI: 0.64, 1.30]; p = 0.62) or hospitalizations (RR = 0.57 [95% CI: 0.17, 1.86]; p = 0.53); emergency department visits were significantly reduced by 75% with BT (RR = 0.25 [95% CI: 0.07, 0.91]; p = 0.04); the proportions of patients with clinically meaningful response on the asthma quality-of-life questionnaire were comparable (RR = 1.06 [95% CI: 0.86, 1.34]; p = 0.59). The RR for exacerbations statistically favours OM over the total study period in AIR2 (RR = 1.50 [95% CI: 1.11, 2.02]; p = 0.009) likely reflecting a transient increase in events during the BT peri-treatment period.

CONCLUSIONS: The ITC should be interpreted cautiously considering the differences between patient populations in the included trials. However, based on the analysis, BT compares well with a potentially more costly pharmacotherapy for asthma. Clinicians evaluating the relative merits of using these treatments should consider the totality of evidence and patient preferences to make an informed decision.

Bibliographical metadata

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalJournal of Asthma
Early online date14 Jul 2017
DOIs
Publication statusPublished - 2017

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