Dual clinical remission in patients treated with biologics for severe asthma and eosinophilic chronic rhinosinusitis

Severe asthma (SA) and eosinophilic chronic rhinosinusitis (ECRS) are characterized by type 2 inflammation, and several biological agents are available. Data on dual clinical remission (CR) in patients with both conditions are limited. To elucidate the proportion of patients achieving dual CR and its predictors among patients with both SA and ECRS, 67 patients (24 males) with both conditions who received biologics for ≥12 months from July 2009 to February 2025 at Jikei University Hospital were retrospectively evaluated. The mean age at biologics initiation was 53.9 years. After switching biologics, the final biologics were omalizumab (1 patient), mepolizumab (13), benralizumab (23), dupilumab (25), tezepelumab (3), and a combination (2). CR for SA occurred in 37 % of patients according to four criteria, i.e., no exacerbation, no systemic corticosteroids (SCS), no symptoms, and stabilization of pulmonary function. For ECRS, 54 patients underwent surgery (mean: 1.6 times). Of the 47 patients who received biologics following surgery, the median time from surgery to biologics initiation was 44 months. CR for ECRS occurred in 60 % of patients according to four criteria, i.e., no symptoms, no SCS, no endoscopic findings, and no need for additional surgery. Dual CR occurred in 25 % of patients, and the predictors included age ≥65 years ( P < 0.0001) and the presence of nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD) as a comorbidity ( P = 0.0003). Dual CR with biologics treatment may be achieved in elderly patients and in those with N-ERD among patients with both SA and ECRS.