Exploring Definitions and Predictors of Severe Asthma Clinical Remission after Biologic Treatment in Adults
- PMID: 38701495
- PMCID: PMC11506911
- DOI: 10.1164/rccm.202311-2192OC
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 + 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.
Figures




Comment in
-
Remission in the World of Severe Asthma.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.
References
-
- Global Initiative for Asthma. https://ginasthma.org/wp-content/uploads/2023/05/GINA-2023-Full-Report-2...
-
- Tuomisto LE, Ilmarinen P, Niemelä O, Haanpää J, Kankaanranta T, Kankaanranta H. A 12-year prognosis of adult-onset asthma: Seinäjoki Adult Asthma Study. Respir Med . 2016;117:223–229. - PubMed
-
- Westerhof GA, Coumou H, de Nijs SB, Weersink EJ, Bel EH. Clinical predictors of remission and persistence of adult-onset asthma. J Allergy Clin Immunol . 2018;141:104–109.e3. - PubMed
-
- Rönmark E, Lindberg A, Watson L, Lundbäck B. Outcome and severity of adult onset asthma: report from the obstructive lung disease in northern Sweden studies (OLIN) Respir Med . 2007;101:2370–2377. - PubMed
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical
Miscellaneous