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. 2024 Jan 23:15:1343362.
doi: 10.3389/fimmu.2024.1343362. eCollection 2024.

Features of severe asthma response to anti-IL5/IL5r therapies: identikit of clinical remission

Giovanna Elisiana Carpagnano  1 , Andrea Portacci  1 , Santi Nolasco  2   3 , Aikaterini Detoraki  4 , Alessandro Vatrella  5 , Cecilia Calabrese  6 , Corrado Pelaia  7 , Francesca Montagnolo  1 , Giulia Scioscia  8 , Giuseppe Valenti  9 , Maria D'Amato  10 , Maria Filomena Caiaffa  11 , Massimo Triggiani  12 , Nicola Scichilone  13 , Claudia Crimi  2   3
Affiliations

Features of severe asthma response to anti-IL5/IL5r therapies: identikit of clinical remission

Giovanna Elisiana Carpagnano et al. Front Immunol. .

Abstract

Introduction: Clinical remission (CliR) achievement has been recognized as a new potential outcome in severe asthma. Nevertheless, we still lack a detailed profile of what features could better identify patients undergoing clinical remission. In this study, we aim to address this issue, tracing a possible identikit of patients fulfilling remission criteria.

Methods: We enrolled 266 patients with severe eosinophilic asthma (SEA) treated with a 12-month course of anti-IL5/IL5 receptor (IL5r) monoclonal antibodies. Patients with no exacerbation, OCS withdrawal, ACT ≥ 20 and FEV1 ≥ 80% after 1 year of biologic treatment were classified as in clinical remission.

Results: 30.5% of the enrolled patients achieved remission after biologic administration. CliR group showed a lower number of baseline asthma exacerbations and better lung function parameters, with a trend for higher ACT scores and a less frequent history of a positive skin prick test. CliR achievement was unlikely in presence of a higher BMI, a positive skin prick test, an increased number of asthma exacerbations before biologic treatment, anti-muscarinic administration, and a previous diagnosis of EGPA, bronchiectasis or osteoporosis. In contrast, a better lung function, an increased blood eosinophilic count, the presence of chronic rhinosinusitis with nasal polyps and a more frequent use of reliever therapy predicts remission development. Changes in exacerbations number, OCS use, ACT scores and FEV1% between remittent and non-remittent patients arise at specific follow up timepoints and are positively associated with CliR achievement.

Discussion: anti-IL5/IL5r biologics can induce CliR in a proportion of patients with SEA. Patients achieving remission demonstrate specific clinical, functional and inflammatory features, as well as a specific moment of improvement in all the CliR items.

Keywords: FEV1; anti-IL5; anti-IL5 receptor; biologics; clinical remission; corticosteroids; exacerbations; severe asthma.

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Conflict of interest statement

GC reported grants or contracts from Astrazeneca, Chiesi, GlaxoSmithKline, Sanofi, Grifols; payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Astrazeneca, GlaxoSmithKline, Sanofi; support for attending meetings and/or travel from Astrazeneca, Menarini, Chiesi. AP reported payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Astrazeneca, GlaxoSmithKline, Chiesi, Sanofi. AD reported payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Astrazeneca, GlaxoSmithKline, Sanofi, Novartis, Lofarma. GS reported payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Astrazeneca, GlaxoSmithKline, Sanofi. GV reported payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from GlaxoSmithKline, Sanofi. MD reported consulting fees from Astrazeneca, GlaxoSmithKline, Sanofi; payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Astrazeneca, GlaxoSmithKline, Sanofi, Novartis; participation on Data Safety Monitoring Board or Advisory Board from Astrazeneca, GlaxoSmithKline, Sanofi. MT reported consulting fees from Astrazeneca, GlaxoSmithKline, Novartis. Nicola Scichilone reported payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Astrazeneca, GlaxoSmithKline, Chiesi, Sanofi. CCr reported payment or honoraria for lectures, presentations, speakers, bureaus, manuscript writing or educational events from Astrazeneca, GlaxoSmithKline, Sanofi, Menarini, ResMed, Fisher&Paykel. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Flow chart showing the enrollment process from the “Southern Italy Network on Severe Asthma Therapy” database.
Figure 2
Figure 2
Differences in (A) exacerbation number, (B) oral corticosteroid administered dose, (C) ACT and (D) FEV1% after 1 year of biologic therapy according to clinical remission achievement. **** P<0.0001.
Figure 3
Figure 3
Main changes in (A) exacerbation number, (B) ACT score and (C) FEV1% according to clinical remission achievement at different follow up timepoints. Data are presented as means and standard deviations for graphical purposes. * P<0.05; **P<0.01.
Figure 4
Figure 4
Receiver operating characteristics (ROC) curves with area under the curves (AUC) for the tested LASSO regression models. Model 1 included all the enrolled patients in the analysis, considering the complete dataset (blue line) and the training dataset of the LASSO regression (orange line). Model 2 only included patients with a recorded FeNO at baseline.
See this image and copyright information in PMC

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