Predictors of Early and Late Lung Function Improvement in Severe Eosinophilic Asthma on Type2-Biologics in the PRISM Study.

Abstract

The determinants linked to the short- and long-term improvement in lung function in patients with severe eosinophilic asthma (SEA) on biological treatment (BioT) remain elusive. We sought to identify the predictors of early and late lung function improvement in patients with SEA after BioT. 140 adult patients with SEA who received mepolizumab, dupilumab, or reslizumab were followed up for 6months to evaluate improvement in forced expiratory volume in one second (FEV1). Logistic regression was used to determine the association between potential prognostic factors and improved lung function at 1 and 6months of treatment. More than a third of patients with SEA using BioT showed early and sustained improvements in FEV1 after 1month. A significant association was found between low baseline FEV1 and high blood eosinophil count and sustained FEV1 improvement after 1month (0.54 [0.37-0.79] and 1.88 [1.28-2.97] odds ratios and 95% confidence interval, respectively). Meanwhile, among patients who did not experience FEV1 improvement after 1month, 39% exhibited improvement at 6months follow-up. A high ACT score measured at this visit was the most reliable predictor of late response after 6months of treatment (OR and 95% CI 1.75 [1.09-2.98]). Factors predicting the efficacy of biological agents that improve lung function in SEA vary according to the stage of response.