Exploring Definitions and Predictors of Severe Asthma Clinical Remission after Biologic Treatment in Adults

Abstract

Rationale: There is no consensus on criteria to include in an asthma remission definition in real life. Factors associated with achieving remission after biologic initiation remain poorly understood. Objectives: To quantify the proportion of adults with severe asthma achieving multidomain-defined remission after biologic initiation and identify prebiologic characteristics associated with achieving remission that may be used to predict it. Methods: This was a longitudinal cohort study using data from 23 countries from the International Severe Asthma Registry. Four asthma outcome domains were assessed in the 1 year before and after biologic initiation. A priori–defined remission cutoffs were: 0 exacerbations/yr, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted FEV1 > 80%. Remission was defined using two (exacerbations 1 LTOCS), three (1control or 1lung function), and four of these domains. The association between prebiologic characteristics and postbiologic remission was assessed by multivariable analysis. Measurements and Main Results: A total of 50.2%, 33.5%, 25.8%, and 20.3% of patients met criteria for two-, three-(1control), three- (1lung function), and four-domain remission, respectively. The odds of achieving four-domain remission decreased by 15% for every additional 10 years of asthma duration (odds ratio, 0.85; 95% confidence interval, 0.73–1.00). The odds of remission increased in those with fewer exacerbations per year, lower LTOCS daily dose, better control, and better lung function before biologic initiation. Conclusions: One in five patients achieved four-domain remission within 1 year of biologic initiation. Patients with less severe impairment and shorter asthma duration at initiation had a greater chance of achieving remission after biologic treatment, indicating that biologic treatment should not be delayed if remission is the goal. Copyright © 2024 by the American Thoracic Society.

• author: Perez-De-Llano, L. ; Bjermer, L.H. and Price, D.B.
• author collaboration: et al.
• organization: Respiratory Medicine, Allergology, and Palliative Medicine; EpiHealth: Epidemiology for Health; Clinical Respiratory Medicine (research group)
• publishing date: 2024
• type: Contribution to journal
• publication status: published
• subject: Respiratory Medicine and Allergy
• keywords: anti-IgE, anti-IL4Ra, anti-IL5/5R, exacerbation, lung function, Adult, Aged, Anti-Asthmatic Agents, Asthma, Biological Products, Cohort Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Registries, Remission Induction, Severity of Illness Index, Treatment Outcome, allergen, biological marker, corticosteroid, immunoglobulin E antibody, interleukin 4 antibody, interleukin 5, leukotriene receptor blocking agent, macrolide, muscarinic receptor blocking agent, theophylline, antiasthmatic agent, biological product, adult, allergy test, anxiety, Article, asthma, Asthma Control Questionnaire, Asthma Control Test, biological therapy, cohort analysis, comorbidity, controlled study, disease duration, disease severity, follow up, forced expiratory volume, human, longitudinal study, osteoporosis, outcome assessment, prevalence, remission, retrospective study, severe asthma, sleep apnea syndromes, aged, drug therapy, female, male, middle aged, pathophysiology, register, severity of illness index, treatment outcome
• in: American Journal of Respiratory and Critical Care Medicine
• volume: 210
• issue: 7
• pages: 12 pages
• publisher: American Thoracic Society
• external identifiers: scopus:85199220176; pmid:38701495
• ISSN: 1073-449X
• DOI: 10.1164/rccm.202311-2192OC
• language: English
• LU publication?: yes
• additional info: Number of authors = 55 EID = 85199220176 Start page = 869 End page = 880 Affiliation = Perez-De-Llano L., Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Spain Affiliation = Wechsler M.E., NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, CO, United States Affiliation = Price D.B., Observational and Pragmatic Research Institute, Singapore, Singapore, Optimum Patient Care Global, Cambridge, United Kingdom, Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
• id: 7ea29280-00ca-49d6-b261-f5ed4160bfd0
• date added to LUP: 2025-12-04 13:54:14
• date last changed: 2025-12-05 03:00:09