Mirror, mirror on the wall: is CompEx the fairest endpoint of all?

Extract Preventing exacerbations is a key goal in asthma management 1. Over the decades, novel asthma biologics have been approved to reduce the risk of exacerbation in patients with severe or uncontrolled asthma 1, 2. Clinical trials have traditionally relied on severe exacerbation (SevEx) as the primary endpoint 3. SevEx is typically defined as events that require systemic corticosteroids, asthma-related hospitalisations, or emergency department visits due to asthma requiring systemic corticosteroids 1, 3. However, using SevEx as the sole endpoint may overlook subtler but impactful worsening events that patients experience daily 3. Therefore, extending beyond SevEx as a single endpoint is important to facilitate the development of new therapies.