Long-term efficacy but rare sustained remission: individual-level 5-year stability in anti-IL5/Rα biologic therapy response for severe asthma

Kjell Erik Julius Håkansson; Susanne Hansen; Marianne Baastrup Soendergaard; Anna von Bülow; Ole Hilberg; Barbara Bonnesen; Claus Rikard Johnsen; Sofie Lock-Johansson; Lycely Dongo; Maria Bisgaard Borup; Roxana Vijdea; Linda Makowska Rasmussen; Johannes Martin Schmid; Charlotte Suppli Ulrik; Celeste Porsbjerg; Anne Sofie Bjerrum

doi:10.1183/13993003.00926-2025

Long-term efficacy but rare sustained remission: individual-level 5-year stability in anti-IL5/Rα biologic therapy response for severe asthma

Kjell Erik Julius Håkansson^*, Susanne Hansen, Marianne Baastrup Soendergaard, Anna von Bülow, Ole Hilberg, Barbara Bonnesen, Claus Rikard Johnsen, Sofie Lock-Johansson, Lycely Dongo, Maria Bisgaard Borup, Roxana Vijdea, Linda Makowska Rasmussen, Johannes Martin Schmid, Charlotte Suppli Ulrik, Celeste Porsbjerg, Anne Sofie Bjerrum

^*Corresponding author for this work

Abstract

BACKGROUND: For a decade, anti-interleukin-5/receptor α (IL5/Rα) has been available to treat severe asthma, with marked reductions in exacerbation rates and maintenance oral corticosteroid burden. However, little is known about long-term, real-world sustained remission. We aimed to assess the stability of response to anti-IL5/Rα over 5 years.

METHODS: All Danish adults initiating anti-IL5/Rα for severe asthma during January 2016 through June 2020 were included. Five-domain remission (no exacerbations, no maintenance oral corticosteroid, forced expiratory volume in 1 s (FEV 1) >80% predicted, Asthma Control Questionnaire score <1.5 and no switch to non-anti-IL5/Rα) was assessed annually for 5 years.

RESULTS: In total, 482 patients were included (median age 56 years, 48% female). At baseline, 13.9% fulfilled the criteria of no exacerbations, 66.0% of no maintenance oral corticosteroid, 29.7% of FEV 1 >80% predicted and 26.5% of Asthma Control Questionnaire score <1.5. At year 5, 18.7% had switched to a non-anti-IL5/Rα biologic.The overall remission rate was 17.6-23.1% over 5 years. However, remission was found to be dynamic; approximately 15.2% of patients in remission per annum did not fulfil the remission criteria the subsequent year. At least 1 year of remission was achieved by 37.4% of patients, with some patients first achieving remission during year 2 or 3.Only 7.7% achieved sustained 5-year remission. Failure to achieve remission was driven by permanently impaired FEV 1 and persistent uncontrolled symptoms. 5-year sustained freedom from exacerbations and maintenance oral corticosteroid use was seen in 33.6% of patients.

CONCLUSIONS: Patients with severe asthma respond well to anti-IL5/Rα, with substantial improvements across all domains over 5 years. Remission is a dynamic state with intermittent relapses, and sustained long-term remission is rare using current domains.

Original language	English
Book series	European Respiratory Journal. Supplement
Volume	67
Issue number	3
ISSN	0904-1850
DOIs	https://doi.org/10.1183/13993003.00926-2025
Publication status	Published - Mar 2026

Keywords

Adrenal Cortex Hormones/therapeutic use
Adult
Aged
Anti-Asthmatic Agents/therapeutic use
Asthma/drug therapy
Biological Therapy/methods
Denmark
Female
Forced Expiratory Volume
Humans
Interleukin-5 Receptor alpha Subunit/antagonists & inhibitors
Male
Middle Aged
Remission Induction
Severity of Illness Index
Surveys and Questionnaires
Treatment Outcome

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10.1183/13993003.00926-2025

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Håkansson, K. E. J., Hansen, S., Soendergaard, M. B., von Bülow, A., Hilberg, O., Bonnesen, B., Johnsen, C. R., Lock-Johansson, S., Dongo, L., Borup, M. B., Vijdea, R., Rasmussen, L. M., Schmid, J. M., Ulrik, C. S., Porsbjerg, C., & Bjerrum, A. S. (2026). Long-term efficacy but rare sustained remission: individual-level 5-year stability in anti-IL5/Rα biologic therapy response for severe asthma. European Respiratory Journal. Supplement, 67(3). https://doi.org/10.1183/13993003.00926-2025

Long-term efficacy but rare sustained remission: individual-level 5-year stability in anti-IL5/Rα biologic therapy response for severe asthma. / Håkansson, Kjell Erik Julius ; Hansen, Susanne ; Soendergaard, Marianne Baastrup et al.
In: European Respiratory Journal. Supplement, Vol. 67, No. 3, 03.2026.

Research output: Contribution to journal › Journal article › Research › peer-review

Håkansson, KEJ , Hansen, S , Soendergaard, MB, von Bülow, A, Hilberg, O, Bonnesen, B, Johnsen, CR, Lock-Johansson, S, Dongo, L, Borup, MB, Vijdea, R, Rasmussen, LM, Schmid, JM, Ulrik, CS , Porsbjerg, C & Bjerrum, AS 2026, 'Long-term efficacy but rare sustained remission: individual-level 5-year stability in anti-IL5/Rα biologic therapy response for severe asthma', European Respiratory Journal. Supplement, vol. 67, no. 3. https://doi.org/10.1183/13993003.00926-2025

@article{24a22cbc43034bf4a09325d145f32fec,

title = "Long-term efficacy but rare sustained remission: individual-level 5-year stability in anti-IL5/Rα biologic therapy response for severe asthma",

abstract = "BACKGROUND: For a decade, anti-interleukin-5/receptor α (IL5/Rα) has been available to treat severe asthma, with marked reductions in exacerbation rates and maintenance oral corticosteroid burden. However, little is known about long-term, real-world sustained remission. We aimed to assess the stability of response to anti-IL5/Rα over 5 years.METHODS: All Danish adults initiating anti-IL5/Rα for severe asthma during January 2016 through June 2020 were included. Five-domain remission (no exacerbations, no maintenance oral corticosteroid, forced expiratory volume in 1 s (FEV 1) >80\% predicted, Asthma Control Questionnaire score <1.5 and no switch to non-anti-IL5/Rα) was assessed annually for 5 years. RESULTS: In total, 482 patients were included (median age 56 years, 48\% female). At baseline, 13.9\% fulfilled the criteria of no exacerbations, 66.0\% of no maintenance oral corticosteroid, 29.7\% of FEV 1 >80\% predicted and 26.5\% of Asthma Control Questionnaire score <1.5. At year 5, 18.7\% had switched to a non-anti-IL5/Rα biologic.The overall remission rate was 17.6-23.1\% over 5 years. However, remission was found to be dynamic; approximately 15.2\% of patients in remission per annum did not fulfil the remission criteria the subsequent year. At least 1 year of remission was achieved by 37.4\% of patients, with some patients first achieving remission during year 2 or 3.Only 7.7\% achieved sustained 5-year remission. Failure to achieve remission was driven by permanently impaired FEV 1 and persistent uncontrolled symptoms. 5-year sustained freedom from exacerbations and maintenance oral corticosteroid use was seen in 33.6\% of patients. CONCLUSIONS: Patients with severe asthma respond well to anti-IL5/Rα, with substantial improvements across all domains over 5 years. Remission is a dynamic state with intermittent relapses, and sustained long-term remission is rare using current domains.",

keywords = "Adrenal Cortex Hormones/therapeutic use, Adult, Aged, Anti-Asthmatic Agents/therapeutic use, Asthma/drug therapy, Biological Therapy/methods, Denmark, Female, Forced Expiratory Volume, Humans, Interleukin-5 Receptor alpha Subunit/antagonists \& inhibitors, Male, Middle Aged, Remission Induction, Severity of Illness Index, Surveys and Questionnaires, Treatment Outcome",

author = "H{\aa}kansson, \{Kjell Erik Julius\} and Susanne Hansen and Soendergaard, \{Marianne Baastrup\} and \{von B{\"u}low\}, Anna and Ole Hilberg and Barbara Bonnesen and Johnsen, \{Claus Rikard\} and Sofie Lock-Johansson and Lycely Dongo and Borup, \{Maria Bisgaard\} and Roxana Vijdea and Rasmussen, \{Linda Makowska\} and Schmid, \{Johannes Martin\} and Ulrik, \{Charlotte Suppli\} and Celeste Porsbjerg and Bjerrum, \{Anne Sofie\}",

note = "Copyright {\textcopyright}The authors 2025. For reproduction rights and permissions contact [email protected].",

year = "2026",

month = mar,

doi = "10.1183/13993003.00926-2025",

language = "English",

volume = "67",

journal = "European Respiratory Journal. Supplement",

issn = "0904-1850",

publisher = "European Respiratory Society",

number = "3",

}

TY - JOUR

T1 - Long-term efficacy but rare sustained remission

T2 - individual-level 5-year stability in anti-IL5/Rα biologic therapy response for severe asthma

AU - Håkansson, Kjell Erik Julius

AU - Hansen, Susanne

AU - Soendergaard, Marianne Baastrup

AU - von Bülow, Anna

AU - Hilberg, Ole

AU - Bonnesen, Barbara

AU - Johnsen, Claus Rikard

AU - Lock-Johansson, Sofie

AU - Dongo, Lycely

AU - Borup, Maria Bisgaard

AU - Vijdea, Roxana

AU - Rasmussen, Linda Makowska

AU - Schmid, Johannes Martin

AU - Ulrik, Charlotte Suppli

AU - Porsbjerg, Celeste

AU - Bjerrum, Anne Sofie

PY - 2026/3

Y1 - 2026/3

N2 - BACKGROUND: For a decade, anti-interleukin-5/receptor α (IL5/Rα) has been available to treat severe asthma, with marked reductions in exacerbation rates and maintenance oral corticosteroid burden. However, little is known about long-term, real-world sustained remission. We aimed to assess the stability of response to anti-IL5/Rα over 5 years.METHODS: All Danish adults initiating anti-IL5/Rα for severe asthma during January 2016 through June 2020 were included. Five-domain remission (no exacerbations, no maintenance oral corticosteroid, forced expiratory volume in 1 s (FEV 1) >80% predicted, Asthma Control Questionnaire score <1.5 and no switch to non-anti-IL5/Rα) was assessed annually for 5 years. RESULTS: In total, 482 patients were included (median age 56 years, 48% female). At baseline, 13.9% fulfilled the criteria of no exacerbations, 66.0% of no maintenance oral corticosteroid, 29.7% of FEV 1 >80% predicted and 26.5% of Asthma Control Questionnaire score <1.5. At year 5, 18.7% had switched to a non-anti-IL5/Rα biologic.The overall remission rate was 17.6-23.1% over 5 years. However, remission was found to be dynamic; approximately 15.2% of patients in remission per annum did not fulfil the remission criteria the subsequent year. At least 1 year of remission was achieved by 37.4% of patients, with some patients first achieving remission during year 2 or 3.Only 7.7% achieved sustained 5-year remission. Failure to achieve remission was driven by permanently impaired FEV 1 and persistent uncontrolled symptoms. 5-year sustained freedom from exacerbations and maintenance oral corticosteroid use was seen in 33.6% of patients. CONCLUSIONS: Patients with severe asthma respond well to anti-IL5/Rα, with substantial improvements across all domains over 5 years. Remission is a dynamic state with intermittent relapses, and sustained long-term remission is rare using current domains.

AB - BACKGROUND: For a decade, anti-interleukin-5/receptor α (IL5/Rα) has been available to treat severe asthma, with marked reductions in exacerbation rates and maintenance oral corticosteroid burden. However, little is known about long-term, real-world sustained remission. We aimed to assess the stability of response to anti-IL5/Rα over 5 years.METHODS: All Danish adults initiating anti-IL5/Rα for severe asthma during January 2016 through June 2020 were included. Five-domain remission (no exacerbations, no maintenance oral corticosteroid, forced expiratory volume in 1 s (FEV 1) >80% predicted, Asthma Control Questionnaire score <1.5 and no switch to non-anti-IL5/Rα) was assessed annually for 5 years. RESULTS: In total, 482 patients were included (median age 56 years, 48% female). At baseline, 13.9% fulfilled the criteria of no exacerbations, 66.0% of no maintenance oral corticosteroid, 29.7% of FEV 1 >80% predicted and 26.5% of Asthma Control Questionnaire score <1.5. At year 5, 18.7% had switched to a non-anti-IL5/Rα biologic.The overall remission rate was 17.6-23.1% over 5 years. However, remission was found to be dynamic; approximately 15.2% of patients in remission per annum did not fulfil the remission criteria the subsequent year. At least 1 year of remission was achieved by 37.4% of patients, with some patients first achieving remission during year 2 or 3.Only 7.7% achieved sustained 5-year remission. Failure to achieve remission was driven by permanently impaired FEV 1 and persistent uncontrolled symptoms. 5-year sustained freedom from exacerbations and maintenance oral corticosteroid use was seen in 33.6% of patients. CONCLUSIONS: Patients with severe asthma respond well to anti-IL5/Rα, with substantial improvements across all domains over 5 years. Remission is a dynamic state with intermittent relapses, and sustained long-term remission is rare using current domains.

KW - Adrenal Cortex Hormones/therapeutic use

KW - Adult

KW - Aged

KW - Anti-Asthmatic Agents/therapeutic use

KW - Asthma/drug therapy

KW - Biological Therapy/methods

KW - Denmark

KW - Female

KW - Forced Expiratory Volume

KW - Humans

KW - Interleukin-5 Receptor alpha Subunit/antagonists & inhibitors

KW - Male

KW - Middle Aged

KW - Remission Induction

KW - Severity of Illness Index

KW - Surveys and Questionnaires

KW - Treatment Outcome

U2 - 10.1183/13993003.00926-2025

DO - 10.1183/13993003.00926-2025

M3 - Journal article

C2 - 41309267

SN - 0904-1850

VL - 67

JO - European Respiratory Journal. Supplement

JF - European Respiratory Journal. Supplement

IS - 3

ER -

Long-term efficacy but rare sustained remission: individual-level 5-year stability in anti-IL5/Rα biologic therapy response for severe asthma

Abstract

Keywords

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