Long term clinical remission on biologics: an analysis of real-world data from the UK severe asthma registry

Background
Clinical remission on biologics is an achievable goal for patients with severe asthma (SA). Most reports present short term follow-up, include small cohort sizes or present data on patients included in clinical trials.
Objective
This study evaluates clinical remission rates in a real-world cohort of patients over the course of up to 4 years on different biologics and include those who switched biologic during this period. We also assess barriers and predictors of remission.
Methods
Retrospective study of 525 patients in the UK SA registry who were initiated on a biologic between January 2015 and May 2022. Clinical remission was assessed at two time points: first review (9-24 months) and long-term review (30-48 months), and defined as controlled asthma (ACQ6<1.5), no exacerbations in the preceding 12 months and no maintenance oral corticosteroid use.
Results
Clinical remission was achieved in 25.1% at first review, increasing to 32.1% at long-term reivew. This improvement occurred regardless of biologic switching. Among those in remission at first review, 69.7% remained in remission at long-term review while 45.6% of those in long-term remission had not been in remission at first review. Higher symptoms burden and presence of anxiety/depression was negatively associated with achieving long-term remission. Advanced age at baseline and the presence of nasal polyps increased likelihood of long-term remission.
Conclusion
In this large real-world cohort of patients with SA, there is a progressive increase in remission rates over 4 years, which is influenced by the presence of comorbidities but is largely independent of biologic switching.