Clinical remission and response to biologics in a severe asthma cohort
Published: June 8, 2023
In recent years, biologics (antibody treatments) blocking specific components of asthma inflammation have been introduced for treatment of severe asthma. Assessment of response to these therapies is crucial to decide whether this therapy should be continued, switched, or stopped. Further, the concept of remission as a possible treatment goal in asthma has gained attention. Clinical remission is currently defined as absence of significant asthma symptoms in the absence of asthma attacks (exacerbations) without use of oral corticosteroids for a duration of at least one year.
In this observational study, which was recently published in The Journal of Allergy and Clinical Immunology: In Practice, Milger et al. analyzed the response to biologics and achievement of remission in a large severe asthma registry cohort. The response was graded into good, intermediate, and insufficient using the Biologic Asthma Response Score (BARS). Patients included in the analysis were adults who presented to a severe asthma center and did not use a biologic at baseline. Group B (210 patients) started a biologic after the baseline visit while group A (233 patients) was treated without using a biologic. Even though all patients had severe asthma, group A and B differed in baseline characteristics; notably group B had even more severe disease characteristics with higher symptom load and more asthma attacks in the past year than group A. Outcomes of both groups were compared after 1 year of treatment.
Both groups improved after 1 year of treatment. The majority of patients in group B had a good response (61.4%), while a good response was observed only in 34.8% of group A. Intermediate response was found in 26.7% vs 42.9% and insufficient response in 11.9% vs. 22.3% of patients in group B vs A. Also, clinical remission was achieved more frequently in group B (37.6%) than in group A (17.2%).
The authors concluded that treatment at a severe asthma center improved outcomes, even without use of biologics. However, response to treatment was better and achievement of remission was more likely when a biologic was used, even though these patients had more severe disease characteristics at baseline. This underlines an important role of biologics for improvement of outcomes for patients with severe asthma.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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