C14-07 Remission After Biologic Therapy Initiation in Patients With Severe Asthma: An Evaluation of up to 5 Years of Follow-up in the International Severe Asthma Registry

Abstract Rationale It has been reported that approximately one-third of patients with severe asthma treated with biologics achieve clinical remission at 12 months. However, data on remission patterns over the long term remain scarce. Methods Real-world longitudinal data were extracted from the International Severe Asthma Registry for adult patients with severe asthma who initiated biologic therapy. Patients included in the study had sufficient data to assess their remission status at least 2 years post-initiation. The proportion of patients meeting remission criteria post-initiation was described for each year (up to 5 years), overall and stratifying by remission status at 1 year. All 3-to 4-domain remission definitions included no exacerbation in the prior year and no (or ceased) long-term oral corticosteroid use, in addition to either well/partly controlled asthma, percent predicted FEV1 ≥80%, or both. Additionally, patients in remission at 1 year who had complete data over 3 years of follow-up were categorized into 3 remission patterns: sustained, semi-sustained (remission lost in year 2 or 3, ie at least one remission criterion not met), and non-sustained remission (remission lost in years 2 and 3). Results A total of 2443 patients from 23 countries who initiated biologic therapy between 2007 and 2023 were included in at least one analysis. Most of the cohort was female (59.8%). The mean age was 54.8 years (SD: 13.8) at biologic initiation, with 61.8% initiating anti-IL-5/5R therapy. The proportion of patients in remission showed little variation across study years, ranging 26.0 to 33.3% (4-domain remission definition), 40.1 to 53.4% (3-domain with asthma control), and 30.4 to 35.6% (3-domain with lung function). Using the 4-domain definition, among 363 patients in remission at 1 year, more than 70% remained in remission in subsequent years (Figure). Conversely, of the 1033 patients not in remission at 1 year, 21% or less achieved remission in later years (Figure). In patients who were in remission at 1 year with complete data on the 4-domain remission over 3 years of follow-up (n = 190), 60.0% had sustained remission, 23.2% were semi-sustained, and 16.8% were not sustained. Conclusions Remission status following biologic therapy initiation in patients with severe asthma who met remission criteria in the first year was relatively stable over time, irrespective of the criteria used to assess remission status. Strategies are required to increase remission rates in the first year, as longer-term remission is unlikely among patients who fail to achieve this. This abstract is funded by: This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global Ltd (OPCG) and AstraZeneca Ltd. The International Severe Asthma Registry (ISAR) is operated by OPCG and co-funded by OPCG and AstraZeneca Ltd.