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.
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 |
|---|---|
| Journal | American Journal of Respiratory and Critical Care Medicine |
| Publication status | Accepted/In press - 18 Apr 2024 |
Keywords
- anti-IgE
- anti-IL5/5R
- anti-IL4Rα
- exacerbation
- lung function