Benralizumab-induced asthma remission: impact of different tools and thresholds to define good asthma control

Background: Current definitions of clinical remission (CR) use different tools and thresholds to define good asthma control. Their differential impact on CR rates in severe asthma is poorly understood. Methods: Data from a real-world study in patients with SEA treated with benralizumab (imPROve Asthma, NCT04184284, total number of patients: 244 patients) were analyzed. Four-component CR (4-CR) was defined as: no exacerbations, no systemic steroid treatment, stable or normal lung function and good asthma control, for at least 12 months. The impact of 2 different asthma control measures (Asthma Control Questionnaire, ACQ, and Asthma Control Test, ACT) with varying thresholds for good asthma control (ACQ: ≤1.5 or ≤0.75, ACT: ≥20 or ≥23) on CR rates was examined. Results: Complete data on all remission criteria were available for 131 patients after 12 months of follow-up, and 85 patients after 24 months of follow-up. After 12 months, 4-CR criteria were fulfilled in 42.7 % (ACQ-6≤1.5), 36.9% (ACT≥20), 24.4 % (ACQ-6≤0.75) and 21.5% (ACT≥23) of the patients. After 24 months, 4-CR criteria were fulfilled in 39.2 % (ACQ-6 ≤1.5), 31.8 % (ACT≥20), 22.8 % (ACQ-6≤0.75) and 17.6 % (ACT≥23) of the patients. Conclusion: CR is achievable in a substantial proportion of patients with SEA treated with benralizumab in a real-world setting. CR rates are strongly dependent on definitions of asthma control, with almost twice as high CR rates found using the ACQ-6 ≤1.5 criterion as compared with the ACT≥23 criterion.