Sex comparison in clinical presentation, response, and remission in severe type-2 asthma patients treated with biologics: a real-world analysis from the “Southern Italy Network on Severe Asthma Therapy”

Background: Sex influences asthma phenotypes and treatment outcomes. However, real-world data on sex-related differences in response to biologics are limited. Objective: To assess sex differences in baseline characteristics and treatment response in a cohort of severe asthma patients treated with biologics. Methods: We retrospectively analyzed 370 patients (235 females, 135 males) treated with mepolizumab, benralizumab or dupilumab. Clinical remission was defined as no OCS use plus at least two of: no exacerbations, ACT ≥20, or FEV1 >80%. Logistic regression was used to identify sex-specific predictors of remission at 24 months. Results: Females were more prevalent. Males had higher FeNO levels; females showed higher obesity and osteoporosis; males had more smoking history and nasal polyposis. Treatment outcomes and remission rates were similar across sexes. In females, remission was associated with eosinophils >300/μL, FeNO >50 ppb, and nasal polyposis; obesity, smoking, anxiety, and reflux were negative predictors. In males, OCS-dependency and FEV1 <80% were negative predictors. Conclusion: Biologics were equally effective across sexes, but different predictors influenced outcomes. Sex-aware strategies may support personalized asthma care.