Clinical Remission in Patients With Biologic-Naïve Asthma: A Multicenter Study in Japan

Abstract

Background: Clinical remission (CR) is a new realistic management goal for patients with asthma, regardless of the disease severity.

Objective: To investigate the rate of achievement of CR in patients treated with inhaled corticosteroid/long-acting β₂-agonist (ICS/LABA) and nonbiologics and the characteristics of patients who achieved CR.

Methods: We performed a post hoc analysis from a multicenter, cross-sectional survey in Japan. 3-way CR was defined as the absence of exacerbation, no use of maintenance oral corticosteroids, and the absence of significant asthma symptoms (5-item Asthma Control Questionnaire < 1.5). We defined 4-way CR as 3-way CR plus having normalized lung function (forced expiratory volume in 1 second [%FEV₁] ≥ 80%). Deep remission was defined as 4-way CR plus suppressed type 2 airway inflammation (fraction of exhaled nitric oxide [FeNO] < 35 ppb).

Results: The criteria for 3-way CR, 4-way CR, and deep remission were met by 56.9%, 35.0%, and 24.7% of patients, respectively. Compared with patients who achieved the 3-way CR, unachieved patients have lower %FEV₁ (77.6% vs 85.4%; P < .0001) and higher FeNO levels (42 ppb vs 34 ppb; P = .0182), and there were more discordances in asthma control perception between patient and physicians (38.5% vs 9.3%; P < .0001). Physician-patient discordance was an independent factor that prevented the achievement of the 3-way CR in the logistic regression analysis, even when adjusted for %FEV₁ and FeNO (odds ratio 0.397; P < 0.0001).

Conclusions: Achieving CR in patients treated with ICS/LABA without biologics is challenging. Discrepancies between patient and physician perceptions on asthma control are significant barriers to achieving CR.

Keywords: Asthma; Biologics; Early intervention; ICS/LABA; Remission.