What question did this study set out to answer?

The aim is to validate the safety and feasibility of a 50% dosing interval extension for anti-IL-5 biologics in patients with severe asthma in clinical remission.

March 26, 2026Open Access

Feasibility of a 50% Dosing Interval Extension of Anti–IL-5 Biologics in Patients with Severe Asthma in Clinical Remission: A Real-World Validation Study

Key Points

The aim is to validate the safety and feasibility of a 50% dosing interval extension for anti-IL-5 biologics in patients with severe asthma in clinical remission.
Single-center, real-world, longitudinal study design.
Enrollment of 31 patients with severe asthma in sustained remission for over 12 months.
50% extension of biologic dosing interval evaluated at baseline and after 6 months.
Remission assessed using three- and four-component criteria at specified intervals.
Bayesian logistic and mixed-effects models applied for clinical and biomarker outcome evaluation.
90% of patients achieved a successful 50% dose interval extension over 12 months.
58% of patients maintained four-component remission by study end.
81% of patients met three-component remission criteria.
Only 10% experienced acute exacerbations, indicating a low rate of disease flare-ups.
Peripheral eosinophil counts slightly increased but remained below 300 cells/μL.

Abstract

Background: Initiation criteria for biologic therapies for severe asthma are well established, but guidance on dose reduction or discontinuation remains limited. Sustained clinical remission presents an opportunity to evaluate biologic dose tapering strategies. Objective: To validate a down-titration algorithm by assessing the feasibility and safety of extending the dosing interval of anti–IL-5 biologics (mepolizumab, benralizumab) by 50% in patients with severe asthma in clinical remission. Methods: In this single-center, real-world, longitudinal study, 31 patients with severe asthma and sustained four-component remission for > 12 months were enrolled. The biologic dosing interval was extended by 25% at baseline and by 50% at 6 months if four-component remission was maintained. Remission was assessed at 26 and 52 weeks using established three- and four-component criteria. Bayesian logistic and mixed-effects models were used to evaluate clinical and biomarker outcomes. Results: Over the 12-month study period, a 50% dose interval extension was successfully achieved in 28 out of 31 patients (90%). At study end, 18 patients (58%) remained in four-component remission, while 25 (81%) met three-component remission criteria. Acute exacerbations occurred in 3 patients (10%). Comparison between benralizumab and mepolizumab showed no significant differences. While peripheral eosinophil counts increased slightly, mean levels remained below 300 cells/μL. FeNO levels showed no significant change. Conclusion: Following a 50% extension of anti–IL-5 biologic dosing intervals, full four-component clinical remission was maintained in 58% of patients, while 81% preserved three-component remission with a low exacerbation rate. These findings indicate that a uniform 50% interval extension cannot be applied universally without risk of partial loss of disease control. However, the high proportion of patients maintaining clinically meaningful 3-component remission supports the feasibility of a structured, stepwise dosing-interval extension strategy in selected patients with severe asthma, emphasizing the need for individualized implementation. Keywords: asthma, severe asthma, biological therapy, anti-IL-5 therapy, biological therapy titration

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Cite This Study

Vergles et al. (Sun,) studied this question.

synapsesocial.com/papers/69c4ccf7fdc3bde448918c17 https://doi.org/https://doi.org/10.2147/jaa.s567136

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