P. Jane McDowell, Ron McDowell, John Busby, M. Chad Eastwood, Pujan H. Patel, David J. Jackson, Adel Mansur, Mitesh Patel, Hassan Burhan, Simon Doe, Rekha Chaudhuri, Robin Gore, James W. Dodd, Deepak Subramanian, Thomas Brown, Liam G. Heaney on behalf of the UK Severe Asthma Registry
European Respiratory Journal 2023 62: 2300819; DOI: 10.1183/13993003.00819-2023

Abstract

Background Novel biologic therapies have revolutionised the management of severe asthma with more ambitious treatment aims. Here we analyse the definition of clinical remission as a suggested treatment goal and consider the characteristics associated with clinical remission in a large, real-world severe asthma cohort.

Methods This was a retrospective analysis of severe asthma patients registered in the UK Severe Asthma Registry (UKSAR) who met strict national access criteria for biologics. Patients had a pre-biologics baseline assessment and annual review. The primary definition of clinical remission applied included Asthma Control Questionnaire (ACQ)-5 <1.5 and no oral corticosteroids for disease control and forced expiratory volume in 1 s above lower limit of normal or no more than 100 mL less than baseline.

Results 18.3% of patients achieved the primary definition of remission. The adjusted odds of remission on biologic therapy were 7.44 (95% CI 1.73–31.95)-fold higher in patients with type 2 (T2)-high biomarkers. The adjusted odds of remission were lower in patients who were female (OR 0.61, 95% CI 0.45–0.93), obese (OR 0.49, 95% CI 0.24–0.65) or had ACQ-5 ≥1.5 (OR 0.19, 95% CI 0.12–0.31) pre-biologic therapy. The likelihood of remission reduced by 14% (95% CI 0.76–0.97) for every 10-year increase in disease duration. 12–21% of the cohort attained clinical remission depending on the definition applied; most of those who did not achieve remission failed to meet multiple criteria.

Conclusions 18.3% of patients achieved the primary definition of clinical remission. Remission was more likely in T2-high biomarker patients with shorter duration of disease and less comorbidity. Further research on the optimum time to commence biologics in severe asthma is required.