Exploring Definitions and Predictors of Severe Asthma Clinical Remission Post-Biologic in Adults

Luis Perez-de-Llano, Ghislaine Scelo, Trung N Tran, Tham T Le, Malin Fagerås, Borja G Cosio, Matthew Peters, Paul E Pfeffer, Mona Al-Ahmad, Riyad O Al-Lehebi, Alan Altraja, Celine Bergeron, Leif H Bjermer, Anne S Bjerrum, Lakmini Bulathsinhala, John Busby, Diana J Cano Rosales, Giorgio W Canonica, Victoria A Carter, Jeremy CharriotGeorge C Christoff, Eve J Denton, Delbert R Dorscheid, Maria J Fernandez Sanchez, João A Fonseca, Peter G Gibson, Celine Y Y Goh, Liam G Heaney, Enrico Heffler, Mark Hew, Takashi Iwanaga, Rohit Katial, Mariko S Koh, Piotr Kuna, Désirée E S Larenas-Linnemann, Lauri Lehtimäki, Bassam Mahboub, Neil Martin, Hisako Matsumoto, Andrew N Menzies-Gow, Nikolaos G Papadopoulos, Todor A Popov, Celeste M Porsbjerg, Pujan Patel, Chin K Rhee, Mohsen Sadatsafavi, Camille Taillé, Carlos A Torres-Duque, Ming-Ju Tsai, Charlotte S Ulrik, John W Upham, Anna von Bülow, Eileen Wang, Michael E Wechsler, David B Price

Abstract

RATIONALE: There is no consensus on criteria to include in an asthma remission definition in real-life. Factors associated with achieving remission post-biologic-initiation remain poorly understood.

OBJECTIVES: To quantify the proportion of adults with severe asthma achieving multi-domain-defined remission post-biologic-initiation and identify pre-biologic characteristics associated with achieving remission which 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 pre- and post-biologic-initiation. A priori-defined remission cut-offs were: 0 exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted forced expiratory volume in one second ≥80%. Remission was defined using 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. The association between pre-biologic characteristics and post-biologic remission was assessed by multivariable analysis.

MEASUREMENTS AND MAIN RESULTS: 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for 2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving 4-domain remission decreased by 15% for every additional 10-years asthma duration (odds ratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewer exacerbations/year, lower LTOCS daily dose, better control and better lung function pre-biologic-initiation.

CONCLUSIONS: One in 5 patients achieved 4-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 post-biologic, indicating that biologic treatment should not be delayed if remission is the goal. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Original languageEnglish
JournalAmerican Journal of Respiratory and Critical Care Medicine
ISSN1073-449X
DOIs
Publication statusE-pub ahead of print - 3 May 2024

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