Sex differences in clinical risk factors and type-2 biomarkers for predicting asthma attacks in the ORACLE2 patient-level meta-analysis

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Rationale: Multiple risk factors for asthma attacks have been identified, including clinical characteristics, blood eosinophil count (BEC), and exhaled nitric oxide (FeNO). However, the impact of sex on their prognostic value is unclear. Aim: To investigate sex differences in prognostic values of clinical characteristics, BEC and FeNO for severe asthma attacks. Methods: We used the ORACLE2 patient-level meta-analysis of 22 randomized controlled asthma trials’ control arms. Sex-specific characteristics were compared [interquartile range], annualized severe asthma attack rate (ASAAR) ratios were derived from negative binomial models. Results: Among 4,140 women and 2,370 men, ASAAR was higher in women (0.9) than in men (0.74 attacks/patient-year). Women were slightly older (50 [40-59] vs 49 [37-59] years), had higher BMI (28.2 [24.3-33.5] vs 27.6 [24.9-30.9] kg/m2), had more severe asthma (41% GINA step 5 vs 36%), and more comorbid depression/anxiety (15 vs 8%). Prior attacks more strongly predicted future attacks in men (Fig1A). Differences in other risk factors between sexes were minor. BEC and FeNO showed similar prognostic value across sexes, except for a trend towards more asthma attacks in FeNO-low women; and FeNO-/BEC-high men (Fig1B). erj;66/suppl_69/PA5744/F1 F1 F1 Conclusion: The annualized asthma attack rate was higher in women than in men. We found a stronger predictive value of prior attacks in men.

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