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. 2024 Oct 1;210(7):869-880.
doi: 10.1164/rccm.202311-2192OC.

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

Affiliations

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

Luis Perez-de-Llano et al. Am J Respir Crit Care Med. .

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 + LTOCS), three (+control or +lung 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- (+control), three- (+lung 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.

Keywords: anti-IL4Rα; anti-IL5/5R; anti-IgE; exacerbation; lung function.

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Figures

Figure 1.
Figure 1.
Definitions of remission after biologic therapy using strict and relaxed domain cutoffs. *Prednisolone equivalent; Control was assessed by Global Initiative for Asthma control criteria, Asthma Control Questionnaire, or Asthma Control Test; Post-bronchodilator used if available, and prebronchodilator used otherwise, while ensuring that pre- and postbiologic measures were both either pre- or post-bronchodilator. Post-bronchodilator measurements were used for 61.6% of patients with available prebiologic percent predicted FEV1 (ppFEV1) (n = 2,705). The remaining 38.4% of patients were all treated with inhaled corticosteroid/long-acting β2-agonist (i.e., bronchodilator not specifically withheld). LTOCS = long-term oral corticosteroid.
Figure 2.
Figure 2.
Percentage of patients in remission (strict criteria) before and after biologic treatment. ppFEV1 = percent predicted FEV1; LTOCS = long-term oral corticosteroid.
Figure 3.
Figure 3.
Percentage of patients in remission (strict criteria) before and after treatment with anti-IgE, anti-IL5/5R, or anti-IL4Rα. LTOCS = long-term oral corticosteroid; ppFEV1 = percent predicted FEV1.
Figure 4.
Figure 4.
Association between selected prebiologic characteristics and (A) three-domain and (B) four-domain asthma remission in patients with severe asthma. Three-domain remission: 0 exacerbations/yr + no long-term oral corticosteroids (LTOCS) + well- or partly controlled asthma. Four-domain remission: 0 exacerbations/yr + no LTOCS + well- or partly controlled asthma + percent predicted FEV1 (ppFEV1) ⩾ 80%. Gray zones highlight association patterns. *Prebiologic lung function adjustment removed. Asthma duration: age at biologic initiation minus reported age at asthma onset. All odds ratios (ORs) were adjusted for prebiologic asthma-related outcome, including in the considered remission definition, as well as for age and sex. BEC = blood eosinophil count; BMI = body mass index; CI = confidence interval; GINA = Global Initiative for Asthma; LTRA = leukotriene receptor antagonist.

Comment in

  • Remission in the World of Severe Asthma.
    Pavord ID. Pavord ID. Am J Respir Crit Care Med. 2024 Oct 1;210(7):855-857. doi: 10.1164/rccm.202405-0894ED. Am J Respir Crit Care Med. 2024. PMID: 38861332 Free PMC article. No abstract available.

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