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Defining a severe-asthma super-responder

Published: July 13, 2021

Several add-on treatments for severe asthma have been developed in recent years, including monoclonal antibodies targeting type 2 inflammation. In selected patients, these novel treatments can significantly reduce asthma exacerbation frequency and minimise oral corticosteroid burden. While the impacts of these therapies on asthma symptoms have often been relatively modest in large randomised controlled trials, clinicians who treat severe asthma patients are increasingly recognising a subgroup of people who experience remarkable clinical improvements. Sometimes referred to as ‘super-responders’, such patients may report that their lives have been transformed by novel treatments. The lack of an agreed definition has hampered efforts to better understand the super-responder (SR) phenomenon.

In a study published in The Journal of Allergy and Clinical Immunology: In Practice, Upham et al used a modified Delphi process to develop an international consensus-based definition of a severe asthma SR. Eighty-one experts from 24 countries were surveyed via 3 online voting rounds. Consensus required agreement by at least 70% of participants.

Consensus was achieved that the SR definition should be based on persistent improvement across 3 or more criteria assessed over 12 months. Two of the criteria must be major criteria – exacerbation elimination, cessation of maintenance oral corticosteroids and improvement in asthma control by two or more times the minimal clinically important difference. Minor criteria comprised a 75% exacerbation reduction, 500 mL or greater improvement in FEV1 and well-controlled asthma. No double counting of criteria is permitted within the same domain. While study participants thought quality of life (QOL) improvements were likely to be an important part of a SR, many expressed concerns about the limitations of currently available QOL tools and their applicability in severe asthma. Thus, further research is needed to better understand the patient’s perspective in super-responders. This consensus definition is an important prerequisite for better understanding SR prevalence, predictive factors, and the mechanisms involved.

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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