Comparison of clinical remission criteria for severe asthma patients receiving biologic therapy

Abstract

BackgroundThe concept of remission on biological treatment has been suggested as a therapeutic target for patients with severe asthma, composed of 1. no chronic use of systemic steroids, 2. no exacerbations, 3. minimal symptoms, and 4. optimized lung function, for a significant time. However, the criteria for remission are not clearly defined. ObjectiveOur objective was to compare different criteria for remission in subjects receiving biologicals for severe asthma. MethodsA cross-sectional study of adult subjects who receive a stable regimen of a biological for severe asthma for at least 6-months. We compared the proportion of subjects who fulfilled different specific criteria in the four domains, as well as those who achieved different composite outcome measures of clinical remission. ResultsOf 39 subjects, 28 were females (71.8%), mean age 60.4. Twelve were current or past smokers (30.8%). Twelve had prior different biological treatment (30.8%), and 3/39 had more than one previous treatment (7.7%). Current biological included mepolizumab 12/39 (30.8%), dupilumab 11/39 (28.2%), benralizumab 10/39 (25.6%), omalizumab 5/39 (12.8%), reslizumab 1/39 (2.6%). Different specific criteria were achieved in 39–80% of subjects, being highest for no chronic steroid use and lowest for symptoms control and lung function. Overall remission was obtained by 20–41%, depending on definition, with significant variability in agreement between different sets of remission criteria (Cohen's kappa 0.33–0.89). ConclusionClinical remission is achievable in real-world severe asthmatics on biological therapies. The core criteria for remission should be better defined.