Exploring Definitions and Predictors of Severe Asthma Clinical Remission after Biologic Treatment in Adults
Authors: 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 Charriot, George 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
Journal: American Journal of Respiratory and Critical Care Medicine (2024)

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/).