We are excited to share groundbreaking findings on remission as a therapeutic target in "Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults (FULL BEAM remission)", recently published in the American Journal of Respiratory and Critical Care Medicine. This International Severe Asthma Registry (ISAR) study, which spanned 23 countries and followed the asthma journeys of over 3,000 real-life patients with severe asthma, reported the prevalence of remission after starting biologic therapy and identified factors associated with achieving it.
This study found that 1 in 5 patients with severe asthma met the criteria for clinical remission within a year of starting biologic treatments, increasing to 1 in 2 when focusing on the key outcomes of fewer asthma attacks and reduction of long-term oral steroid use (see Figure 1). This was consistent across all types of biologics tested.
Figure 1: Percentage of patients in remission pre- and post-biologic treatment
Abbreviations: LTOCS: long-term oral corticosteroid; ppFEV: percent predicted forced expiratory volume in one second.
What is even more interesting is the profile of patients who benefited most from these treatments. Unlike former observations where patients with worse symptoms see greater response, remission was more likely in patients who had less severe asthma to begin with. The likelihood of remission was increased in those with fewer asthma attacks, lower oral steroid daily dose, better control of asthma symptoms and better lung function prior to biologic initiation. This suggests that starting treatment earlier, before the disease becomes too severe, could be crucial.
Additionally, the study identified predictors of remission, with older age of onset and higher blood eosinophil counts linked with higher odds of remission, and asthma duration, where the likelihood of achieving remission decreased by 15% for every additional 10 years of asthma duration. Higher blood eosinophil counts were found to be particularly linked to higher odds of remission with the biologic therapy anti-IL5/5R (monoclonal antibodies targeting interleukin-5 or its receptor).
In summary, patients with less severe disease and shorter asthma duration at initiation of biologic treatment had a greater chance of achieving remission. The study suggests the need for a shift in severe asthma treatment approaches, emphasizing the need to consider biologics earlier in the course of asthma, before progressing down the path of LTOCS use and before irreversible lung damage can occur. The take-home message? Early intervention with biologics could make a significant difference for patients with severe asthma, potentially leading to better long-term outcomes and higher chances of remission.
To learn more about the study, please read the full publication in the American Journal of Respiratory and Critical Care Medicine (AJRCCM), as well as the accompanying slide deck.
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