Clinical remission in biologic-naive asthma patients

Published online November 6, 2024

With the introduction of biologics and single inhaler triple therapy, there is a growing global interest in achieving remission in asthma. Clinical remission is currently defined as the absence of significant asthma symptoms and the absence of asthma exacerbations without the use of oral corticosteroids for a duration of at least one year. Many countries are defining these criteria, recognizing clinical remission as a new realistic goal in asthma management. Although studies have evaluated clinical remission with the introduction of biologics, clinical remission in biologic-naïve patients have not been adequately studied.

In a recent study, which was published in The Journal of Allergy and Clinical immunology: In Practice, Oishi et al. performed a post hoc analysis from a multicenter, cross-sectional survey in Japan to investigate the rate of clinical remission achievement in patients treated with inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) and other non-biologics. They defined 3-way clinical remission as no exacerbations, no use of maintenance oral corticosteroids, and no significant asthma symptoms (5-item Asthma Control Questionnaire < 1.5). They defined 4-way clinical remission as 3-way clinical remission plus having normalized lung function (forced expiratory volume in one second [%FEV1] ≥ 80%). Deep remission was defined as 4-way clinical remission plus suppressed type-2 airway inflammation (fractional exhaled nitric oxide [FeNO] < 35 ppb).

The achievement rates for the 3-way clinical remission, 4-way clinical remission, and deep remission were 56.9%, 35.0%, and 24.7%, respectively. Compared to patients who achieved the 3-way clinical remission, unachieved patients had lower %FEV1, higher FeNO levels, and there were more discordances in asthma control perception between patient and physicians. Physician-patient discordance was an independent factor that prevented the achievement of the 3-way clinical remission in the logistic regression analysis, even when adjusted for %FEV1 and FeNO. The authors concluded that the rate of clinical remission in patients with biologic-naïve asthma is still unsatisfactory, and that it is important to improve the remission rate by improving physicians' underestimation of asthma control, performing multifaceted asthma assessments, and considering earlier interventions in asthma management.

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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