Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults

Luis Perez-de-Llano; Ghislaine Scelo; Trung N Tran; Tham T Le; Malin Fagerås; Borja G Cosio; Matthew Peters; Paul E Pfeffer; Mona Al-Ahmad; Riyad O Al-Lehebi; Alan Altraja; Celine Bergeron; Leif H Bjermer; Anne S Bjerrum; Lakmini Bulathsinhala; John Busby; Diana J Cano Rosales; Giorgio W Canonica; Victoria A Carter; Jeremy Charriot; George C Christoff; Eve J Denton; Delbert R Dorscheid; Maria J Fernandez Sanchez; João A Fonseca; Peter G Gibson; Celine Y Y Goh; Liam G Heaney; Enrico Heffler; Mark Hew; Takashi Iwanaga; Rohit Katial; Mariko S Koh; Piotr Kuna; Désirée E S Larenas-Linnemann; Lauri Lehtimäki; Bassam Mahboub; Neil Martin; Hisako Matsumoto; Andrew N Menzies-Gow; Nikolaos G Papadopoulos; Todor A Popov; Celeste M Porsbjerg; Pujan Patel; Chin K Rhee; Mohsen Sadatsafavi; Camille Taillé; Carlos A Torres-Duque; Ming-Ju Tsai; Charlotte S Ulrik; John W Upham; Anna von Bülow; Eileen Wang; Michael E Wechsler; David B Price

doi:10.1164/rccm.202311-2192OC

Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults

Luis Perez-de-Llano, Ghislaine Scelo, Trung N Tran, Tham T Le, Malin Fagerås, Borja G Cosio, Matthew Peters, Paul E Pfeffer, Mona Al-Ahmad, Riyad O Al-Lehebi, Alan Altraja, Celine Bergeron, Leif H Bjermer, Anne S Bjerrum, Lakmini Bulathsinhala, John Busby, Diana J Cano Rosales, Giorgio W Canonica, Victoria A Carter, Jeremy CharriotGeorge C Christoff, Eve J Denton, Delbert R Dorscheid, Maria J Fernandez Sanchez, João A Fonseca, Peter G Gibson, Celine Y Y Goh, Liam G Heaney, Enrico Heffler, Mark Hew, Takashi Iwanaga, Rohit Katial, Mariko S Koh, Piotr Kuna, Désirée E S Larenas-Linnemann, Lauri Lehtimäki, Bassam Mahboub, Neil Martin, Hisako Matsumoto, Andrew N Menzies-Gow, Nikolaos G Papadopoulos, Todor A Popov, Celeste M Porsbjerg, Pujan Patel, Chin K Rhee, Mohsen Sadatsafavi, Camille Taillé, Carlos A Torres-Duque, Ming-Ju Tsai, Charlotte S Ulrik, John W Upham, Anna von Bülow, Eileen Wang, Michael E Wechsler, David B Price

School of Medicine, Dentistry and Biomedical Sciences

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Abstract

RATIONALE: There is no consensus on criteria to include in an asthma remission definition in real-life. Factors associated with achieving remission post-biologic-initiation remain poorly understood.

OBJECTIVES: To quantify the proportion of adults with severe asthma achieving multi-domain-defined remission post-biologic-initiation and identify pre-biologic characteristics associated with achieving remission which may be used to predict it.

METHODS: This was a longitudinal cohort study using data from 23 countries from the International Severe Asthma Registry. Four asthma outcome domains were assessed in the 1-year pre- and post-biologic-initiation. A priori-defined remission cut-offs were: 0 exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted forced expiratory volume in one second ≥80%. Remission was defined using 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. The association between pre-biologic characteristics and post-biologic remission was assessed by multivariable analysis.

MEASUREMENTS AND MAIN RESULTS: 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for 2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving 4-domain remission decreased by 15% for every additional 10-years asthma duration (odds ratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewer exacerbations/year, lower LTOCS daily dose, better control and better lung function pre-biologic-initiation.

CONCLUSIONS: One in 5 patients achieved 4-domain remission within 1-year of biologic-initiation. Patients with less severe impairment and shorter asthma duration at initiation had a greater chance of achieving remission post-biologic, indicating that biologic treatment should not be delayed if remission is the goal.

Original language	English
Pages (from-to)	869-880
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	210
Issue number	7
Early online date	03 May 2024
DOIs	https://doi.org/10.1164/rccm.202311-2192OC
Publication status	Published - 01 Oct 2024

Keywords

anti-IL4Rα
anti-IL5/5R
anti-IgE
exacerbation
lung function

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Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults
Copyright 2024 the authors. This is an open access article published under a Creative Commons Attribution-NonCommercial-NoDerivs License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits distribution and reproduction for non-commercial purposes, provided the author and source are cited.
Final published version, 1.19 MBLicence: CC BY-NC-ND

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Perez-de-Llano, L., Scelo, G., Tran, T. N., Le, T. T., Fagerås, M., Cosio, B. G., Peters, M., Pfeffer, P. E., Al-Ahmad, M., Al-Lehebi, R. O., Altraja, A., Bergeron, C., Bjermer, L. H., Bjerrum, A. S., Bulathsinhala, L., Busby, J., Cano Rosales, D. J., Canonica, G. W., Carter, V. A., ... Price, D. B. (2024). Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults. American Journal of Respiratory and Critical Care Medicine, 210(7), 869-880. https://doi.org/10.1164/rccm.202311-2192OC

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abstract = "RATIONALE: There is no consensus on criteria to include in an asthma remission definition in real-life. Factors associated with achieving remission post-biologic-initiation remain poorly understood.OBJECTIVES: To quantify the proportion of adults with severe asthma achieving multi-domain-defined remission post-biologic-initiation and identify pre-biologic characteristics associated with achieving remission which may be used to predict it.METHODS: This was a longitudinal cohort study using data from 23 countries from the International Severe Asthma Registry. Four asthma outcome domains were assessed in the 1-year pre- and post-biologic-initiation. A priori-defined remission cut-offs were: 0 exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted forced expiratory volume in one second ≥80%. Remission was defined using 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. The association between pre-biologic characteristics and post-biologic remission was assessed by multivariable analysis.MEASUREMENTS AND MAIN RESULTS: 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for 2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving 4-domain remission decreased by 15% for every additional 10-years asthma duration (odds ratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewer exacerbations/year, lower LTOCS daily dose, better control and better lung function pre-biologic-initiation.CONCLUSIONS: One in 5 patients achieved 4-domain remission within 1-year of biologic-initiation. Patients with less severe impairment and shorter asthma duration at initiation had a greater chance of achieving remission post-biologic, indicating that biologic treatment should not be delayed if remission is the goal.",

keywords = "anti-IL4Rα, anti-IL5/5R, anti-IgE, exacerbation, lung function",

author = "Luis Perez-de-Llano and Ghislaine Scelo and Tran, {Trung N} and Le, {Tham T} and Malin Fager{\aa}s and Cosio, {Borja G} and Matthew Peters and Pfeffer, {Paul E} and Mona Al-Ahmad and Al-Lehebi, {Riyad O} and Alan Altraja and Celine Bergeron and Bjermer, {Leif H} and Bjerrum, {Anne S} and Lakmini Bulathsinhala and John Busby and {Cano Rosales}, {Diana J} and Canonica, {Giorgio W} and Carter, {Victoria A} and Jeremy Charriot and Christoff, {George C} and Denton, {Eve J} and Dorscheid, {Delbert R} and {Fernandez Sanchez}, {Maria J} and Fonseca, {Jo{\~a}o A} and Gibson, {Peter G} and Goh, {Celine Y Y} and Heaney, {Liam G} and Enrico Heffler and Mark Hew and Takashi Iwanaga and Rohit Katial and Koh, {Mariko S} and Piotr Kuna and Larenas-Linnemann, {D{\'e}sir{\'e}e E S} and Lauri Lehtim{\"a}ki and Bassam Mahboub and Neil Martin and Hisako Matsumoto and Menzies-Gow, {Andrew N} and Papadopoulos, {Nikolaos G} and Popov, {Todor A} and Porsbjerg, {Celeste M} and Pujan Patel and Rhee, {Chin K} and Mohsen Sadatsafavi and Camille Taill{\'e} and Torres-Duque, {Carlos A} and Ming-Ju Tsai and Ulrik, {Charlotte S} and Upham, {John W} and {von B{\"u}low}, Anna and Eileen Wang and Wechsler, {Michael E} and Price, {David B}",

year = "2024",

month = oct,

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doi = "10.1164/rccm.202311-2192OC",

language = "English",

volume = "210",

pages = "869--880",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "American Thoracic Society",

number = "7",

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Perez-de-Llano, L, Scelo, G, Tran, TN, Le, TT, Fagerås, M, Cosio, BG, Peters, M, Pfeffer, PE, Al-Ahmad, M, Al-Lehebi, RO, Altraja, A, Bergeron, C, Bjermer, LH, Bjerrum, AS, Bulathsinhala, L, Busby, J, Cano Rosales, DJ, Canonica, GW, Carter, VA, Charriot, J, Christoff, GC, Denton, EJ, Dorscheid, DR, Fernandez Sanchez, MJ, Fonseca, JA, Gibson, PG, Goh, CYY, Heaney, LG, Heffler, E, Hew, M, Iwanaga, T, Katial, R, Koh, MS, Kuna, P, Larenas-Linnemann, DES, Lehtimäki, L, Mahboub, B, Martin, N, Matsumoto, H, Menzies-Gow, AN, Papadopoulos, NG, Popov, TA, Porsbjerg, CM, Patel, P, Rhee, CK, Sadatsafavi, M, Taillé, C, Torres-Duque, CA, Tsai, M-J, Ulrik, CS, Upham, JW, von Bülow, A, Wang, E, Wechsler, ME & Price, DB 2024, 'Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults', American Journal of Respiratory and Critical Care Medicine, vol. 210, no. 7, pp. 869-880. https://doi.org/10.1164/rccm.202311-2192OC

TY - JOUR

T1 - Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults

AU - Perez-de-Llano, Luis

AU - Scelo, Ghislaine

AU - Tran, Trung N

AU - Le, Tham T

AU - Fagerås, Malin

AU - Cosio, Borja G

AU - Peters, Matthew

AU - Pfeffer, Paul E

AU - Al-Ahmad, Mona

AU - Al-Lehebi, Riyad O

AU - Altraja, Alan

AU - Bergeron, Celine

AU - Bjermer, Leif H

AU - Bjerrum, Anne S

AU - Bulathsinhala, Lakmini

AU - Busby, John

AU - Cano Rosales, Diana J

AU - Canonica, Giorgio W

AU - Carter, Victoria A

AU - Charriot, Jeremy

AU - Christoff, George C

AU - Denton, Eve J

AU - Dorscheid, Delbert R

AU - Fernandez Sanchez, Maria J

AU - Fonseca, João A

AU - Gibson, Peter G

AU - Goh, Celine Y Y

AU - Heaney, Liam G

AU - Heffler, Enrico

AU - Hew, Mark

AU - Iwanaga, Takashi

AU - Katial, Rohit

AU - Koh, Mariko S

AU - Kuna, Piotr

AU - Larenas-Linnemann, Désirée E S

AU - Lehtimäki, Lauri

AU - Mahboub, Bassam

AU - Martin, Neil

AU - Matsumoto, Hisako

AU - Menzies-Gow, Andrew N

AU - Papadopoulos, Nikolaos G

AU - Popov, Todor A

AU - Porsbjerg, Celeste M

AU - Patel, Pujan

AU - Rhee, Chin K

AU - Sadatsafavi, Mohsen

AU - Taillé, Camille

AU - Torres-Duque, Carlos A

AU - Tsai, Ming-Ju

AU - Ulrik, Charlotte S

AU - Upham, John W

AU - von Bülow, Anna

AU - Wang, Eileen

AU - Wechsler, Michael E

AU - Price, David B

PY - 2024/10/1

Y1 - 2024/10/1

N2 - RATIONALE: There is no consensus on criteria to include in an asthma remission definition in real-life. Factors associated with achieving remission post-biologic-initiation remain poorly understood.OBJECTIVES: To quantify the proportion of adults with severe asthma achieving multi-domain-defined remission post-biologic-initiation and identify pre-biologic characteristics associated with achieving remission which may be used to predict it.METHODS: This was a longitudinal cohort study using data from 23 countries from the International Severe Asthma Registry. Four asthma outcome domains were assessed in the 1-year pre- and post-biologic-initiation. A priori-defined remission cut-offs were: 0 exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted forced expiratory volume in one second ≥80%. Remission was defined using 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. The association between pre-biologic characteristics and post-biologic remission was assessed by multivariable analysis.MEASUREMENTS AND MAIN RESULTS: 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for 2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving 4-domain remission decreased by 15% for every additional 10-years asthma duration (odds ratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewer exacerbations/year, lower LTOCS daily dose, better control and better lung function pre-biologic-initiation.CONCLUSIONS: One in 5 patients achieved 4-domain remission within 1-year of biologic-initiation. Patients with less severe impairment and shorter asthma duration at initiation had a greater chance of achieving remission post-biologic, indicating that biologic treatment should not be delayed if remission is the goal.

AB - RATIONALE: There is no consensus on criteria to include in an asthma remission definition in real-life. Factors associated with achieving remission post-biologic-initiation remain poorly understood.OBJECTIVES: To quantify the proportion of adults with severe asthma achieving multi-domain-defined remission post-biologic-initiation and identify pre-biologic characteristics associated with achieving remission which may be used to predict it.METHODS: This was a longitudinal cohort study using data from 23 countries from the International Severe Asthma Registry. Four asthma outcome domains were assessed in the 1-year pre- and post-biologic-initiation. A priori-defined remission cut-offs were: 0 exacerbations/year, no long-term oral corticosteroid (LTOCS), partly/well-controlled asthma, and percent predicted forced expiratory volume in one second ≥80%. Remission was defined using 2 (exacerbations + LTOCS), 3 (+control or +lung function) and 4 of these domains. The association between pre-biologic characteristics and post-biologic remission was assessed by multivariable analysis.MEASUREMENTS AND MAIN RESULTS: 50.2%, 33.5%, 25.8% and 20.3% of patients met criteria for 2, 3 (+control), 3 (+lung function) and 4-domain-remission, respectively. The odds of achieving 4-domain remission decreased by 15% for every additional 10-years asthma duration (odds ratio: 0.85; 95% CI: 0.73, 1.00). The odds of remission increased in those with fewer exacerbations/year, lower LTOCS daily dose, better control and better lung function pre-biologic-initiation.CONCLUSIONS: One in 5 patients achieved 4-domain remission within 1-year of biologic-initiation. Patients with less severe impairment and shorter asthma duration at initiation had a greater chance of achieving remission post-biologic, indicating that biologic treatment should not be delayed if remission is the goal.

KW - anti-IL4Rα

KW - anti-IL5/5R

KW - anti-IgE

KW - exacerbation

KW - lung function

U2 - 10.1164/rccm.202311-2192OC

DO - 10.1164/rccm.202311-2192OC

M3 - Article

C2 - 38701495

SN - 1073-449X

VL - 210

SP - 869

EP - 880

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 7

ER -

Exploring definitions and predictors of severe asthma clinical remission post-biologic in adults

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Keywords

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