Decreased Healthcare Utilization in Children With Severe Asthma 1-year After Biologics: An Interrupted Times Series Analysis
Bibliographic record
Abstract
Abstract Rationale: In Canada, asthma is the most common chronic respiratory disease in children. Some children present with severe asthma, where they continue to experience symptoms such as poor sleep, school absenteeism and frequent exacerbations despite compliance with inhaled pharmacotherapy. An additional solution is the prescribed use of monoclonal antibody therapies (“biologics”) which target inflammatory mediators in patients with severe asthma. However, biologics are cost-prohibitive (∼$50,000 CAD/patient/year). Therefore, understanding the effectiveness of biologics on health outcomes and utilization in children with severe asthma will help identify the best populations for biologic use. Methods: A retrospective cohort study of children (6-18y) with severe asthma using biologics were identified using Observational Medical Outcomes Partnership (OMOP) Common Data Model system, a standardized data registry for electronic health records. Children using any combination of biologics (omalizumab [OM], mepolizumab [ME], or dupilumab [DU]), treated at the Hospital for Sick Children (Toronto) from May 2018 to March 2024 were included. Health outcomes (emergency department [ED] visits, hospitalizations, eosinophil count [EOS], lung function) were compared 1-year before and after initiation of biologics treatment. Logistic regressions were used to estimate odds ratios (OR) with 95% confidence intervals (CI) of asthma ED visits and hospitalizations. Interrupted time series (ITS) analysis was conducted to measure absolute effects of biologics. Results: A total of 7,178 children with asthma were identified, of whom 44 had severe asthma treated with biologics (OM = 30; DU =11; ME=3). The mean age (SD) was 13.3 (3.3) years and 21 (48%) were females. After biologics, inhaled and oral corticosteroids use decreased by 30.8% and 17.6%, respectively. ED visits per-patient year (PYR) declined from 0.88 to 0.06, with incidence rate ratio (IRR) of 14.0 (95% CI 4.47, 70.61). Asthma hospitalizations PYR also declined from 0.54 to 0.06, with IRR of 8.67 (95% CI 2.66, 44.74). The ITS analysis showed ED visits decreased from 3.0 to 0.2 before and after biologics, with absolute differences of -5.2 (95% CI -8, -2.4). Similarly, hospitalizations dropped from 2.0 to 0.2, with absolute differences of -2.4 (95% CI -4.3, -0.58). EOS was reduced from 535 to 399 cells/mcL, with absolute effect -329 (95% CI -254, -92). There were no statistical differences in pulmonary functions before and after biologics (Table 1). Conclusions: Asthma biologics significantly reduced acute healthcare utilization and EOS in children with severe asthma. Future studies need to evaluate the effects of biologics on patient-reported outcomes and when biologics may be weaned.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.004 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".