TY - JOUR
T1 - Exploring definitions and predictors of severe asthma clinical remission after biologic treatment in adults
AU - Perez-de-Llano, Luis
AU - Scelo, Ghislaine
AU - Tran, Trung N.
AU - Le, Tham T.
AU - Fagerås, 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 J.
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 J.
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 S.
AU - Kuna, Piotr
AU - Larenas-Linnemann, Désirée E. S.
AU - Lehtimaki, Lauri
AU - Mahboub, Bassam
AU - Martin, Neil
AU - Matsumoto, Hisako
AU - Menzies-Gow, Andrew N.
AU - Papadopoulos, Nikolaos G.
AU - Popov, Todor A.
AU - Porsbjerg, Celeste M.
AU - Patel, Pujan
AU - Rhee, Chin K.
AU - Sadatsafavi, Mohsen
AU - Taille, Camille
AU - Torres-Duque, Carlos A.
AU - Tsai, Ming Ju
AU - Ulrik, Charlotte S.
AU - Upham, John W.
AU - von Bülow, Anna
AU - Wang, Eileen
AU - Wechsler, Michael E.
AU - Price, David B.
N1 - Copyright 2024 by the American Thoracic Society. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2024/10/1
Y1 - 2024/10/1
N2 - Rationale: There is no consensus on criteria to include in an asthma remission definition in real life. Factors associated with achieving remission after biologic initiation remain poorly understood. Objectives: To quantify the proportion of adults with severe asthma achieving multidomain-defined remission after biologic initiation and identify prebiologic characteristics associated with achieving remission that 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 before and after biologic initiation. A priori–defined remission cutoffs were: 0 exacerbations/yr, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted FEV1 > 80%. Remission was defined using two (exacerbations 1 LTOCS), three (1control or 1lung function), and four of these domains. The association between prebiologic characteristics and postbiologic remission was assessed by multivariable analysis. Measurements and Main Results: A total of 50.2%, 33.5%, 25.8%, and 20.3% of patients met criteria for two-, three-(1control), three- (1lung function), and four-domain remission, respectively. The odds of achieving four-domain remission decreased by 15% for every additional 10 years of asthma duration (odds ratio, 0.85; 95% confidence interval, 0.73–1.00). The odds of remission increased in those with fewer exacerbations per year, lower LTOCS daily dose, better control, and better lung function before biologic initiation. Conclusions: One in five patients achieved four-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 after biologic treatment, indicating that biologic treatment should not be delayed if remission is the goal.
AB - Rationale: There is no consensus on criteria to include in an asthma remission definition in real life. Factors associated with achieving remission after biologic initiation remain poorly understood. Objectives: To quantify the proportion of adults with severe asthma achieving multidomain-defined remission after biologic initiation and identify prebiologic characteristics associated with achieving remission that 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 before and after biologic initiation. A priori–defined remission cutoffs were: 0 exacerbations/yr, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted FEV1 > 80%. Remission was defined using two (exacerbations 1 LTOCS), three (1control or 1lung function), and four of these domains. The association between prebiologic characteristics and postbiologic remission was assessed by multivariable analysis. Measurements and Main Results: A total of 50.2%, 33.5%, 25.8%, and 20.3% of patients met criteria for two-, three-(1control), three- (1lung function), and four-domain remission, respectively. The odds of achieving four-domain remission decreased by 15% for every additional 10 years of asthma duration (odds ratio, 0.85; 95% confidence interval, 0.73–1.00). The odds of remission increased in those with fewer exacerbations per year, lower LTOCS daily dose, better control, and better lung function before biologic initiation. Conclusions: One in five patients achieved four-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 after biologic treatment, indicating that biologic treatment should not be delayed if remission is the goal.
KW - anti-IgE
KW - anti-IL4Ra
KW - anti-IL5/5R
KW - exacerbation
KW - lung function
UR - http://www.scopus.com/inward/record.url?scp=85199220176&partnerID=8YFLogxK
U2 - 10.1164/rccm.202311-2192OC
DO - 10.1164/rccm.202311-2192OC
M3 - Article
C2 - 38701495
AN - SCOPUS:85199220176
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 -