Abstract Rationale Remission in patients with severe asthma initiating biologic therapy is a recent field of research. Available data are largely limited to the first year of treatment, with remission rates varying by the criteria used. Little is known about the long-term clinical benefits of achieving early remission after biologic initiation. Methods Real-world longitudinal data from adult patients with severe asthma who initiated a biologic therapy was extracted from the International Severe Asthma Registry. Patients included in the study had available remission status at 1-year post-initiation and available data on exacerbations, lung function, asthma control, and/or long-term oral corticosteroid (LTOCS) use during at least 2 years post-initiation. Remission definitions included no exacerbation and no (or ceased) LTOCS use in the prior year, in addition to either well/partly controlled asthma, percent predicted FEV1 ≥80%, or both. Study outcomes were exacerbations, asthma control, percent predicted FEV1, and LTOCS use measured 2 to 5 years after biologic initiation. We used generalised linear models to estimate the associations between 1-year remission status and longer-term clinical outcomes adjusted for age, sex, geographical setting, and pre-biologic measures of the outcomes of interest. Results A total of 3371 patients from 24 countries were included in at least one analysis. They initiated biologics between 2007 and 2023 with 61.1% receiving an anti-IL5/5R. Most of the cohort was female (60.0%). The mean age was 54.2 years (SD: 14.2) at biologic initiation. Remission criteria were met at 1 year by 24.9% of patients (564/2268) using the four-domain definition, 38.6% (1020/2645) using the 3-domain definition with asthma control, and 29.9% (894/2994) using the 3-domain definition with lung function. Patients who met remission at 1 year demonstrated better long-term outcomes consistently and up to 5 years post initiation compared to those who did not. Specifically, they experienced 3-5 times fewer exacerbations in subsequent years (p 0.05), had 2-4 times greater odds of having well-controlled asthma (p 0.05), exhibited a 7-10 higher percentage-points of percent predicted FEV1 (p 0.05), and were less likely to use LTOCS (p 0.05) (Figure). Results were consistent across remission definitions. Conclusions Among patients with severe asthma receiving biologic therapy, achieving remission within the first year is associated with clinically important improvements in asthma-related outcomes sustained up to 5 years. These findings highlight the importance of reaching remission early after biologic treatment initiation, as it may predict sustained asthma control, reduced exacerbations, and better lung function. 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.
Scelo et al. (Fri,) studied this question.
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