Firstly, to screen blood exosomal multi-omics (transcriptomics, proteomics, metabolomics) and lung radiomics (HRCT, Xe129MRI) biomarkers that can predict efficacy and prognosis in severe eosinophilic ACOS (asthma-COPD overlap) patients treated with different biologics (benralizumab, mepolizumab, dupilumab). Then, to prospectively follow patients for 48 weeks after biologic initiation and collect clinical data, blood samples, and imaging features. Finally, to build a multi-dimensional predictive model for efficacy and prognosis of severe eosinophilic ACOS.
Firstly, eligible patients (age ≥14 years, diagnosis of severe eosinophilic ACOS, blood eosinophils ≥150/μL within 3 months or ≥300/μL within 1 year, and clinician decision to start a biologic) will be enrolled. Exclusion criteria include concurrent trial participation, allergy to biologics, malignancy, or prior biologic use. Then, patients are followed for 48 weeks after the first biologic dose. Visits occur at weeks 0, 1, 2, 4, 8, 16, 24, 40, and 48. Data collected include demographics, medical history, ACQ-6, MiniAQLQ, pre-BD FEV1, exacerbations, medication use, adverse events, and blood routine tests (residual samples for exosome analysis). HRCT and Xe129MRI are optional. Next, the primary outcome is the composite endpoint of efficacy and prognosis at week 48, defined as: no ACOS exacerbation, no oral corticosteroids, pre-BD FEV1 improvement ≥100 mL from baseline, and ACQ-6 score \<1.5 (or ≤0.75). Secondary outcomes include changes in ACQ-6, FEV1, annualized exacerbation rate, MiniAQLQ, OCS dose reduction, and blood exosomal multi-omics and lung radiomics biomarkers. Finally, statistical analyses include descriptive statistics, paired t-test/Wilcoxon, ANOVA/Kruskal-Wallis, mixed-effects model for repeated measures (MMRM), differential expression analysis (DESeq2/limma), pathway enrichment, machine learning (LASSO, random forest), ROC curves, logistic regression, and Cox regression. A total of 500 patients will be enrolled from multiple centers in China.
Study Type
OBSERVATIONAL
Enrollment
500
Union hospital, Tongji Medical college, Huazhong University of Science and Technology
Wuhan, Hubei, China
Composite efficacy and prognosis endpoint at week 48 in severe eosinophilic ACOS
We define the composite endpoint as achieving ALL of the following at week 48: (1) no ACOS exacerbation (worsening of respiratory symptoms requiring systemic corticosteroids ≥3 days, emergency visit \<24h, or hospitalization ≥24h); (2) no use of oral corticosteroids (OCS); (3) pre-bronchodilator FEV1 improvement ≥100 mL from baseline; (4) ACQ-6 score \<1.5 (or ≤0.75). The proportion of patients meeting all four criteria will be calculated.
Time frame: 48 weeks after the first dose of biologic
Change in Asthma Control Questionnaire-6 (ACQ-6) score
ACQ-6 is a validated questionnaire (6 items, score 0-6, lower = better control). Change from baseline will be assessed at weeks 1,2,4,8,16,24,40,48. Mean difference and standard deviation will be reported.
Time frame: Baseline to 48 weeks
Change in pre-bronchodilator FEV1 (mL)
FEV1 (forced expiratory volume in 1 second) will be measured using spirometry according to international standards (ATS/ERS). Change in mL from baseline will be calculated at weeks 8, 16, and 48.
Time frame: Baseline to 48 weeks
Annualized rate of ACOS exacerbations
Number of ACOS exacerbations per year during the 48-week follow-up. Exacerbation defined as worsening of respiratory symptoms requiring systemic corticosteroids (≥3 days), emergency department visit (\<24 hours), or hospitalization (≥24 hours). Rate = (total exacerbations × 365.25) / follow-up days.
Time frame: 48 weeks
Change in Mini Asthma Quality of Life Questionnaire (MiniAQLQ) score
MiniAQLQ is a 15-item questionnaire (score 1-7, higher = better quality of life). Change from baseline will be assessed at weeks 8, 16, 24, and 48.
Time frame: Baseline to 48 weeks
Change in blood exosomal multi-omics biomarkers
Residual blood from routine tests (2-3 mL per time point at weeks 0,4,8,16,24,40,48) will be used to isolate exosomes. Transcriptomics (RNA-seq), proteomics (mass spectrometry), and metabolomics (LC-MS) profiles will be compared between baseline and week 48. Differentially expressed features (\|log2FC\|\>1, FDR\<0.05) will be reported.
Time frame: Baseline to 48 weeks
Change in lung radiomics features
For patients who undergo HRCT or Xe129MRI (optional), radiomics features (e.g., texture, shape, intensity) will be extracted using standard software. Changes from baseline to week 24 and 48 will be analyzed.
Time frame: Baseline to 48 weeks
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