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Easier access to biologics is associated with a greater likelihood of achieving clinical remission and other favorable outcomes in severe asthma

Q: What is the Biologic Accessibility Score (BACS)?

BACS is a composite score of prescription criteria for biologics in severe asthma, used as a proxy for ease of access. Higher scores indicate less restrictive access.

Q: How was clinical remission defined in this study?

Clinical remission was defined using 2, 3, and 4 domains, including no exacerbations, well- or partly controlled asthma, lung function (ppFEV1 or ppPEFR ≥80%), and no long-term oral corticosteroid use.

Q: What were the main findings?

Countries with easier access to biologics had higher proportions of patients achieving clinical remission, fewer exacerbations, better asthma control, better lung function, and less long-term steroid use one year after starting biologics.

Q: Does this study prove that easier access causes better outcomes?

No, this is an ecological study, so it only shows associations at the country level. The authors state that further studies are needed to establish causality.

This ecological study of 9,183 severe asthma patients from 21 countries found that countries with easier access to biologics (higher Biologic Accessibility Score, BACS) had higher proportions of patients achieving clinical remission (p≤0.001), no exacerbations (p<0.001), well- or partly controlled asthma (p=0.047), ppFEV1 or ppPEFR ≥80% (p=0.004), and no long-term oral corticosteroid use (p=0.045) one year after biologic initiation. The findings suggest that reducing barriers to biologic access may improve outcomes, but causality requires further confirmation.

Last updated: Aug 26, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100

Human RCT☆☆☆☆☆

Meta-analysis☆☆☆☆☆

Mechanism★★★★★

Safety★★★★☆

Confidencelow

Study Evidence

Study 1. Association of Easier Biologic Access with Remission and Other Clinical Outcomes in Severe Asthma: A Global Real-World Study.

observational

Hansen S, Tsai MJ, Tran TN, Blakey JD, Emmanuel B, Aaron SD, Habis Y, Perugini V, Altraja A, Katial RK, Perez-de-Llano L, Pfeffer PE, Papadopoulos NG, Townend J, Scelo G, Beastall A, Bulathsinhala L, Busby J, Lindsley AW, Moore WC, Panettieri RA, Canonica GW, Heffler E, Cardini C, Guida G, Porsbjerg CM, Bjerrum AS, Von Bülow A, Hilberg O, Håkansson KEJ, Soendergaard MB, Ulrik CS, Wang E, Wechsler ME, Chapman N, Hoyte FCL, Otsu K, Heaney LG, Jackson DJ, Patel PH, Ryan D, Bergeron C, Abercromby S, Bhutani M, Chapman KR, Côté A, Davis BE, Dorscheid DR, Hoshyari L, Philipenko B, Serajeddini H, Schleich F, Louis R, Kuna P, Cosio BG, Larenas-Linnemann D, Torres-Duque CA, Fernández-Sánchez MJ, Garcia E, Bolívar-Grimaldos F, Jiménez-Maldonado L, Cano-Rosales DJ, Solarte I, Al-Lehebi R, Bulkhi AA, Al-Ahmad M, Iwanaga T, Hozawa S, Matsumoto H, Nagano T, Tajiri T, Aarli BB, Perng DW, Hsiao YH, Fu PK, Sheu CC, Kostikas K, Gaga M, Gogali A, Kallieri M, Loukides S, Makris M, Ntakoula MD, Papaioannou AI, Paraskevopoulos G, Psarros F, Mahboub B, Salameh L, Koh MS, Liew MF, Pang PH, Tan TL, Tay TR, Pitrez PM, Rhee CK, Lugogo N, Mohan A, Fonseca JA, da Silva AA, Loureiro CC, Dos Santos HCAS, Máspero JF, Ardusso LRF, Franchi ME, Sivori M, Stok AM, Yañez A, Christoff G, Popov TA, Mitchell PD, Salvi SS, Costello RW, Denton E, Hew M, Jenkins CR, Langton D, Middleton PG, Peters MJ, Lehtimäki L, Bourdin A, Taillé C, Taube C, Csoma Z, Lúdvíksdóttir D, van Boven JFM, Fingleton J, Bjermer L, Emery H, Lough G, Pleasants RA, Maselli DJ, Ambrose CS, Emmas C, Menzies-Gow AN, Carter V, Eleangovan N, Murray RB, Price CA, Sadatsafavi M, Price DB · Journal of asthma and allergy (2026)

Participants: N/A

Duration: 1 year post-biologic initiation

Intervention: Country-level biologic accessibility score (BACS) as a proxy for ease of access to biologics

Outcome: Clinical remission (defined using 2, 3, and 4 domains), no exacerbations, asthma control (well- or partly controlled), ppFEV1 or ppPEFR ≥80%, no long-term oral corticosteroid use

Effect Size: N/A (p-values reported: p≤0.001 for remission, p<0.001 for no exacerbations, p=0.047 for control, p=0.004 for lung function, p=0.045 for no LTOCS)

Population: Patients with severe asthma from 21 countries, enrolled in CHRONICLE, ISAR, or OPCRD registries

Result:

PubMed: 42638984 DOI: 10.2147/JAA.S597657

Mechanism Graph

Biologic accessibility score (BACS) reflects prescription criteria and reimbursement barriers

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Higher BACS indicates easier access to biologics, likely leading to shorter time-to-initiation

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Earlier initiation of biologics may alter disease trajectory before irreversible damage occurs

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Result: Easier access is associated with improved clinical outcomes, including remission

Limitations

⚠Ecological study design: associations at country level may not reflect individual-level causality
⚠Confounding by healthcare system factors, socioeconomic status, or disease severity not fully accounted for
⚠Outcome definitions varied across registries and may not be directly comparable
⚠Observational data cannot establish causal relationship between access and outcomes

Frequently Asked Questions

What is the Biologic Accessibility Score (BACS)?▼

BACS is a composite score of prescription criteria for biologics in severe asthma, used as a proxy for ease of access. Higher scores indicate less restrictive access.

How was clinical remission defined in this study?▼

Clinical remission was defined using 2, 3, and 4 domains, including no exacerbations, well- or partly controlled asthma, lung function (ppFEV1 or ppPEFR ≥80%), and no long-term oral corticosteroid use.

What were the main findings?▼

Countries with easier access to biologics had higher proportions of patients achieving clinical remission, fewer exacerbations, better asthma control, better lung function, and less long-term steroid use one year after starting biologics.

Does this study prove that easier access causes better outcomes?▼

No, this is an ecological study, so it only shows associations at the country level. The authors state that further studies are needed to establish causality.

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References

1.Hansen S, Tsai MJ, Tran TN, Blakey JD, Emmanuel B, Aaron SD, Habis Y, Perugini V, Altraja A, Katial RK, Perez-de-Llano L, Pfeffer PE, Papadopoulos NG, Townend J, Scelo G, Beastall A, Bulathsinhala L, Busby J, Lindsley AW, Moore WC, Panettieri RA, Canonica GW, Heffler E, Cardini C, Guida G, Porsbjerg CM, Bjerrum AS, Von Bülow A, Hilberg O, Håkansson KEJ, Soendergaard MB, Ulrik CS, Wang E, Wechsler ME, Chapman N, Hoyte FCL, Otsu K, Heaney LG, Jackson DJ, Patel PH, Ryan D, Bergeron C, Abercromby S, Bhutani M, Chapman KR, Côté A, Davis BE, Dorscheid DR, Hoshyari L, Philipenko B, Serajeddini H, Schleich F, Louis R, Kuna P, Cosio BG, Larenas-Linnemann D, Torres-Duque CA, Fernández-Sánchez MJ, Garcia E, Bolívar-Grimaldos F, Jiménez-Maldonado L, Cano-Rosales DJ, Solarte I, Al-Lehebi R, Bulkhi AA, Al-Ahmad M, Iwanaga T, Hozawa S, Matsumoto H, Nagano T, Tajiri T, Aarli BB, Perng DW, Hsiao YH, Fu PK, Sheu CC, Kostikas K, Gaga M, Gogali A, Kallieri M, Loukides S, Makris M, Ntakoula MD, Papaioannou AI, Paraskevopoulos G, Psarros F, Mahboub B, Salameh L, Koh MS, Liew MF, Pang PH, Tan TL, Tay TR, Pitrez PM, Rhee CK, Lugogo N, Mohan A, Fonseca JA, da Silva AA, Loureiro CC, Dos Santos HCAS, Máspero JF, Ardusso LRF, Franchi ME, Sivori M, Stok AM, Yañez A, Christoff G, Popov TA, Mitchell PD, Salvi SS, Costello RW, Denton E, Hew M, Jenkins CR, Langton D, Middleton PG, Peters MJ, Lehtimäki L, Bourdin A, Taillé C, Taube C, Csoma Z, Lúdvíksdóttir D, van Boven JFM, Fingleton J, Bjermer L, Emery H, Lough G, Pleasants RA, Maselli DJ, Ambrose CS, Emmas C, Menzies-Gow AN, Carter V, Eleangovan N, Murray RB, Price CA, Sadatsafavi M, Price DB. "Association of Easier Biologic Access with Remission and Other Clinical Outcomes in Severe Asthma: A Global Real-World Study.." Journal of asthma and allergy, 2026. PMID: 42638984 DOI: 10.2147/JAA.S597657

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