Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults

Luis Perez de Llano; Ghislaine Scelo; Trung N Tran; Malin  Faregås; 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 Jimena  Cano-Rosales; Giorgio W Canonica; Victoria A Carter; Jeremy  Charriot; George C Christoff; Eve J.  Denton; Delbert R.  Dorscheid; Maria Jose  Fernandez-Sanchez; João A. Fonseca; Peter G.  Gibson; Celine Y.Y. Goh; Liam G Heaney; Enrico Heffler; Mark Hew; Takashi Iwanaga; Rohit  Katial; Mariko Siyue Koh; Piotr Kuna; Désirée E.S.  Larenas-Linnemann; Lauri Lehtimäki; Bassam Mahboub; Neil  Martin; Hisako  Matsumoto; Andrew Menzies-Gow; Nikolaos G Papadopoulos; Todor A Popov; Celeste M. Porsbjerg; Pujan H  Patel; Chin Kook Rhee; Mohsen Sadatsafavi; Camille  Taillé; Carlos A.  Torres-Duque; Ming-Ju  Tsai; Charlotte  Suppli Ulrik; John W Upham; Anna  von Bülow; Eileen Wang; Michael E Wechsler; David Price

doi:10.1164/rccm.202311-2192OC

Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults

Luis Perez de Llano, Ghislaine Scelo, Trung N Tran, Malin Faregås, 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 Jimena Cano-Rosales, Giorgio W Canonica, Victoria A Carter, Jeremy Charriot, George C ChristoffEve J. Denton, Delbert R. Dorscheid, Maria Jose Fernandez-Sanchez, João A. Fonseca, Peter G. Gibson, Celine Y.Y. Goh, Liam G Heaney, Enrico Heffler, Mark Hew, Takashi Iwanaga, Rohit Katial, Mariko Siyue Koh, Piotr Kuna, Désirée E.S. Larenas-Linnemann, Lauri Lehtimäki, Bassam Mahboub, Neil Martin, Hisako Matsumoto, Andrew Menzies-Gow, Nikolaos G Papadopoulos, Todor A Popov, Celeste M. Porsbjerg, Pujan H Patel, Chin Kook Rhee, Mohsen Sadatsafavi, Camille Taillé, Carlos A. Torres-Duque, Ming-Ju Tsai, Charlotte Suppli Ulrik, John W Upham, Anna von Bülow, Eileen Wang, Michael E Wechsler, David Price^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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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 pre348 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.

Original language	English
Pages (from-to)	869-880
Number of pages	12
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	210
Issue number	7
Early online date	3 May 2024
DOIs	https://doi.org/10.1164/rccm.202311-2192OC
Publication status	Published - 1 Oct 2024

Data Availability Statement

No data availability statement.

Keywords

anti-IgE
anti-IL5/5R
anti-IL4Rα
exacerbation
lung function

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Perez de Llano, L., Scelo, G., Tran, T. N., Faregås, M., Cosio, B. G., Peters, M., Pfeffer, P. E., Al-Ahmad, M., Al-Lehebi, R. O., Altraja, A., Bergeron , C., Bjermer, L. H., Bjerrum, A. S., Bulathsinhala, L., Busby, J., Cano-Rosales, D. J., Canonica, G. W., Carter, V. A., Charriot, J., ... Price, D. (2024). Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults. American Journal of Respiratory and Critical Care Medicine, 210(7), 869-880. https://doi.org/10.1164/rccm.202311-2192OC

Perez de Llano, L, Scelo, G, Tran, TN, Faregås, M, Cosio, BG, Peters, M, Pfeffer, PE, Al-Ahmad, M, Al-Lehebi, RO, Altraja, A, Bergeron , C, Bjermer, LH, Bjerrum, AS, Bulathsinhala, L, Busby, J, Cano-Rosales, DJ, Canonica, GW, Carter, VA, Charriot, J, Christoff, GC, Denton, EJ, Dorscheid, DR, Fernandez-Sanchez, MJ, Fonseca, JA, Gibson, PG, Goh, CYY, Heaney, LG, Heffler, E, Hew, M, Iwanaga, T, Katial, R, Koh, MS, Kuna, P, Larenas-Linnemann, DES, Lehtimäki, L, Mahboub, B, Martin, N, Matsumoto, H, Menzies-Gow, A, Papadopoulos, NG, Popov, TA, Porsbjerg, CM, Patel, PH, Rhee, CK, Sadatsafavi, M, Taillé, C, Torres-Duque, CA, Tsai, M-J, Suppli Ulrik, C, Upham, JW, von Bülow, A, Wang, E, Wechsler, ME & Price, D 2024, 'Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults', American Journal of Respiratory and Critical Care Medicine, vol. 210, no. 7, pp. 869-880. https://doi.org/10.1164/rccm.202311-2192OC

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title = "Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults",

abstract = "Rationale: There is no consensus on criteria to include in an asthma remission definition inreal-life. Factors associated with achieving remission post-biologic-initiation remain poorlyunderstood.Objectives: To quantify the proportion of adults with severe asthma achieving multi-domain defined remission post-biologic-initiation and identify pre-biologic characteristics associatedwith 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: 0exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma,and percent predicted forced expiratory volume in one second ≥80%. Remission was definedusing 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. Theassociation between pre-biologic characteristics and post-biologic remission was assessed bymultivariable analysis.Measurements and main results: 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving4-domain remission decreased by 15% for every additional 10-years asthma duration (oddsratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewerexacerbations/year, lower LTOCS daily dose, better control and better lung function pre348 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 hada greater chance of achieving remission post-biologic, indicating that biologic treatmentshould not be delayed if remission is the goal.",

keywords = "anti-IgE, anti-IL5/5R, anti-IL4Rα, exacerbation, lung function",

author = "{Perez de Llano}, Luis and Ghislaine Scelo and Tran, {Trung N} and Malin Fareg{\aa}s and Cosio, {Borja G.} and Matthew Peters and Pfeffer, {Paul E} and Mona Al-Ahmad and Al-Lehebi, {Riyad O.} and Alan Altraja and Celine Bergeron and Bjermer, {Leif H.} and Bjerrum, {Anne S.} and Lakmini Bulathsinhala and John Busby and Cano-Rosales, {Diana Jimena} and Canonica, {Giorgio W} and Carter, {Victoria A} and Jeremy Charriot and Christoff, {George C} and Denton, {Eve J.} and Dorscheid, {Delbert R.} and Fernandez-Sanchez, {Maria Jose} and Fonseca, {Jo{\~a}o A.} and Gibson, {Peter G.} and Goh, {Celine Y.Y.} and Heaney, {Liam G} and Enrico Heffler and Mark Hew and Takashi Iwanaga and Rohit Katial and Koh, {Mariko Siyue} and Piotr Kuna and Larenas-Linnemann, {D{\'e}sir{\'e}e E.S.} and Lauri Lehtim{\"a}ki and Bassam Mahboub and Neil Martin and Hisako Matsumoto and Andrew Menzies-Gow and Papadopoulos, {Nikolaos G} and Popov, {Todor A} and Porsbjerg, {Celeste M.} and Patel, {Pujan H} and Rhee, {Chin Kook} and Mohsen Sadatsafavi and Camille Taill{\'e} and Torres-Duque, {Carlos A.} and Ming-Ju Tsai and {Suppli Ulrik}, Charlotte and Upham, {John W} and {von B{\"u}low}, Anna and Eileen Wang and Wechsler, {Michael E} and David Price",

year = "2024",

month = oct,

day = "1",

doi = "10.1164/rccm.202311-2192OC",

language = "English",

volume = "210",

pages = "869--880",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "American Thoracic Society - AJRCCM",

number = "7",

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TY - JOUR

T1 - Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults

AU - Perez de Llano, Luis

AU - Scelo, Ghislaine

AU - Tran, Trung N

AU - Faregås, Malin

AU - Cosio, Borja G.

AU - Peters, Matthew

AU - Pfeffer, Paul E

AU - Al-Ahmad, Mona

AU - Al-Lehebi, Riyad O.

AU - Altraja, Alan

AU - Bergeron , Celine

AU - Bjermer, Leif H.

AU - Bjerrum, Anne S.

AU - Bulathsinhala, Lakmini

AU - Busby, John

AU - Cano-Rosales, Diana Jimena

AU - Canonica, Giorgio W

AU - Carter, Victoria A

AU - Charriot, Jeremy

AU - Christoff, George C

AU - Denton, Eve J.

AU - Dorscheid, Delbert R.

AU - Fernandez-Sanchez, Maria Jose

AU - Fonseca, João A.

AU - Gibson, Peter G.

AU - Goh, Celine Y.Y.

AU - Heaney, Liam G

AU - Heffler, Enrico

AU - Hew, Mark

AU - Iwanaga, Takashi

AU - Katial, Rohit

AU - Koh, Mariko Siyue

AU - Kuna, Piotr

AU - Larenas-Linnemann, Désirée E.S.

AU - Lehtimäki, Lauri

AU - Mahboub, Bassam

AU - Martin, Neil

AU - Matsumoto, Hisako

AU - Menzies-Gow, Andrew

AU - Papadopoulos, Nikolaos G

AU - Popov, Todor A

AU - Porsbjerg, Celeste M.

AU - Patel, Pujan H

AU - Rhee, Chin Kook

AU - Sadatsafavi, Mohsen

AU - Taillé, Camille

AU - Torres-Duque, Carlos A.

AU - Tsai, Ming-Ju

AU - Suppli Ulrik, Charlotte

AU - Upham, John W

AU - von Bülow, Anna

AU - Wang, Eileen

AU - Wechsler, Michael E

AU - Price, David

PY - 2024/10/1

Y1 - 2024/10/1

N2 - Rationale: There is no consensus on criteria to include in an asthma remission definition inreal-life. Factors associated with achieving remission post-biologic-initiation remain poorlyunderstood.Objectives: To quantify the proportion of adults with severe asthma achieving multi-domain defined remission post-biologic-initiation and identify pre-biologic characteristics associatedwith 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: 0exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma,and percent predicted forced expiratory volume in one second ≥80%. Remission was definedusing 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. Theassociation between pre-biologic characteristics and post-biologic remission was assessed bymultivariable analysis.Measurements and main results: 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving4-domain remission decreased by 15% for every additional 10-years asthma duration (oddsratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewerexacerbations/year, lower LTOCS daily dose, better control and better lung function pre348 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 hada greater chance of achieving remission post-biologic, indicating that biologic treatmentshould not be delayed if remission is the goal.

AB - Rationale: There is no consensus on criteria to include in an asthma remission definition inreal-life. Factors associated with achieving remission post-biologic-initiation remain poorlyunderstood.Objectives: To quantify the proportion of adults with severe asthma achieving multi-domain defined remission post-biologic-initiation and identify pre-biologic characteristics associatedwith 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: 0exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma,and percent predicted forced expiratory volume in one second ≥80%. Remission was definedusing 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. Theassociation between pre-biologic characteristics and post-biologic remission was assessed bymultivariable analysis.Measurements and main results: 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving4-domain remission decreased by 15% for every additional 10-years asthma duration (oddsratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewerexacerbations/year, lower LTOCS daily dose, better control and better lung function pre348 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 hada greater chance of achieving remission post-biologic, indicating that biologic treatmentshould not be delayed if remission is the goal.

KW - anti-IgE

KW - anti-IL5/5R

KW - anti-IL4Rα

KW - exacerbation

KW - lung function

U2 - 10.1164/rccm.202311-2192OC

DO - 10.1164/rccm.202311-2192OC

M3 - Article

C2 - 38701495

SN - 1073-449X

VL - 210

SP - 869

EP - 880

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 7

ER -

Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults

Abstract

Data Availability Statement

Keywords

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