Relation between treatable traits, treatment (Tx) choices and symptom control/exacerbation (exac) risk in moderate–severe asthma

<bold>Introduction</bold> Appropriate individualisation of asthma Tx requires identifying relevant determinants of control/risk including Tx effect. <bold>Aim</bold> To quantify effects of baseline characteristics/Tx on symptom control (Asthma Control Questionnaire [ACQ-5]) and exac risk reduction in moderate–severe asthma. <bold>Methods</bold> Exac and ACQ-5 were simulated for 1 year (yr) via time-to-event and longitudinal models (based on data: 6763 patients [pts], 9 studies). Heat maps separated baseline characteristics/Tx effects. To mimic clinical practice, data from a 16000 pt-cohort were modelled to initiate on fluticasone propionate, then stepped-up to fluticasone furoate/vilanterol (FF/VI) or budesonide/formoterol (BUD/FOR) if symptoms were not well controlled (ACQ-5 ≥1.5) in 0.25yr. A log-rank test analysed cumulative exac. <bold>Results</bold> ACQ-5, body mass index (BMI), sex, smoking and forced expiratory volume in 1 second % predicted affect exac risk independently of Tx (p<0.01). Cumulative exac frequency after 1yr was ~11% lower in pts with baseline ACQ-5 ≤0.75 vs >1.5 (p<0.01). Step-up to FF/VI resulted in lower exac rate vs BUD/FOR (14.7% vs 23.9%; p<0.01; Fig 1). At 1yr, 81.1% and 75.7% of pts on FF/VI and BUD/FOR had ACQ-5 ≤1.5 (p<0.01), respectively. <bold>Conclusions</bold> ACQ-5/exac risk are modulated by pt characteristics (BMI, sex), asthma control, lung function and Tx, highlighting personalised asthma management importance. <fig><object-id>erj;64/suppl_68/PA4118/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>