Exploring Definitions and Predictors of Severe Asthma Clinical Remission after Biologic Treatment in Adults
Luis Pérez de Llano, Ghislaine Scélo, Trung N. Tran, Tham Le, Malin Fagerås, Borja G. Cosío, Matthew Peters, Paul Pfeffer, Mona Al‐Ahmad, Riyad Al‐Lehebi, Alan Altraja, Céline Bergeron, Leif Bjermer, Anne Sofie Bjerrum, Lakmini Bulathsinhala, John Busby, Diana Jimena Cano Rosales, Giorgio Walter Canonica, Victoria Carter, Jérémy Charriot, George Christoff, Eve Denton, Delbert R. Dorscheid, María José Fernández Sánchez, João Fonseca, Peter G. Gibson, Celine Goh, Liam G. Heaney, Enrico Heffler, Mark Hew, Takashi Iwanaga, Rohit Katial, Mariko Siyue Koh, Piotr Kuna, Désirée Larenas‐Linnemann, Lauri Lehtimäki, Bassam Mahboub, Neil Martin, Hisako Matsumoto, Andrew Menzies‐Gow, Nikolaos G. Papadopoulos, Todor A. Popov, Celeste Porsbjerg, Pujan 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
Abstract
Abstract 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 + LTOCS), three (+control or +lung 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- (+control), three- (+lung 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.