C38-11 Clinical Remission at 12 Months With Dupilumab in Severe Asthma: A Real-world Cohort From Brazilian Private Practice

Abstract Rationale Clinical remission, defined as sustained symptom control, no exacerbations, and no daily oral corticosteroid (OCS) use, is an emerging target in severe asthma. While IL-4/IL-13 blockade improves outcomes in type 2 disease, real-world remission rates remain uncertain in Brazilian private practice. Methods A retrospective observational cohort of consecutive adults with severe asthma treated with dupilumab was analyzed in a specialized private clinic in Brazil (Dec 1, 2020-Dec 1, 2024). Data from routine care were abstracted at baseline and 12 months. The primary endpoint was 12-month clinical remission (Asthma Control Test ACT ≥20, zero exacerbations, and no daily OCS). Paired complete-case analyses were prespecified (no imputation). Continuous paired outcomes were tested with Wilcoxon; paired binary outcomes with McNemar’s exact test (α = 0.05, two-sided). Exploratory analyses assessed remission by comorbidities (chronic rhinosinusitis with nasal polyps CRSwNP, chronic rhinosinusitis CRS, chronic obstructive pulmonary disease COPD, allergic bronchopulmonary aspergillosis ABPA, gastroesophageal reflux disease GERD) and by biologic-naïve vs. switchers (prior biologic exposure). Between-group comparisons used Fisher’s exact test with risk ratio (RR), risk difference (RD), and 95% CIs. Specific IgE sensitization (RAST) was recorded. Results Twenty-three patients initiated dupilumab. Baseline characteristics: median age 63 years (IQR 41.5-68.5); 60.9% male; eosinophils 280 cells/µL (IQR 204-385); total IgE 128 IU/mL (IQR 86.5-212.5); allergen sensitization 73.9% (predominantly mites/dust). Comorbidities: CRSwNP 30.4%, COPD 13.0%, CRS 8.7%, ABPA 8.7%, GERD 8.7%; none 30.4%. Switchers comprised 47.8%. Thirteen patients completed ≥12 months and were eligible for paired analyses. From baseline to 12 months, ACT improved from 9 (IQR 5-15.8) to 25 (IQR 24-25) (p 0.05) and annualized exacerbations decreased from 4.0 (IQR 3-4) to 1.0 (IQR 0-1) (p 0.05). For any exacerbation, 0 worsened and 10 improved (McNemar p = 0.00195). Daily OCS use decreased (5 stopped; none started; McNemar p = 0.0625). Clinical remission occurred in 6/13 (46.2%; exact 95% CI 19-75). Exploratory remission by comorbidity among eligibles: CRSwNP 40%, CRS 50%, ABPA 100%, none 66.7%; COPD and other single-patient comorbidities showed no remission. Remission was 50.0% (95% CI 15.2-84.8) in switchers vs 40.0% (95% CI 5.3-85.3) in biologic-naïve (RR≈1.25; RD≈+10 percentage points; Fisher p = 1.00). Conclusions Under routine private-practice conditions in Brazil, dupilumab was associated with substantial improvements in symptoms and exacerbations and a 12-month clinical remission rate of 46.2% among fully evaluated patients. These real-world data, applying a strict three-component definition, support remission as a feasible therapeutic target and may inform shared decision-making and local care pathways. This abstract is funded by: None