A Real-World Study on Clinical Remission of Asthma Patients on Biologics

Abstract Rationale: Biologic treatments improve clinical outcomes in asthma by targeting specific pathways involved in airway inflammation and immune response, resulting in long-term disease control and remission in a subset of patients. Multiple parameters define clinical remission in asthma, but there is no consensus currently. Furthermore, previous studies have not yet determined a method for clinicians to predict remission likelihood using such parameters. Therefore, this study aims to evaluate a simple scoring method and its ability to predict clinical remission in a cohort of asthma patients prescribed various biologic medications. Methods: In this retrospective study, we reviewed the medical charts of patients currently or previously treated with biologics (mepolizumab, omalizumab, and benralizumab). Each patient is given a remission score based on the number of exacerbations experienced in the past year, Asthma Control Questionnaire (ACQ)-5 score, Forced Expiratory Volume in one second (FEV-1), and biomarkers assessing lung inflammation (e.g., fractional exhaled nitric oxide and blood eosinophil counts (BEC)) (Figure 1A). Scoring 1.5 or lower on the scoring system indicates remission. Scores closer to 1.5 suggest a higher probability of achieving remission with biologics. We compared clinical remission scores and their components (BEC, FEV1) among patients on different biologics from baseline to 5 years post-treatment. Results: Among 146 patients (mean age 61± 14 years, mean BMI 28.2 ± 7.1, 55% female, 98% non-smokers), 36% were prescribed mepolizumab, 36% omalizumab, and 19% benralizumab. In the past year, 84% had no exacerbations requiring oral corticosteroids, 8% had one, and 8% had two or more. Results showed an overall decrease in remission scores from 2.48 to 1.27 five years post-biologics initiation, with details by biologic shown in Figure 1B. One year post-biologic treatment, 49.2% of patients on mepolizumab, 15% on benralizumab, and 10.75% on omalizumab achieved clinical remission according to the scoring tool (Figure 1C). Five years post-biologic initiation, 46%, 39%, and 45% of patients on benralizumab, mepolizumab, and omalizumab, respectively, had FEV1 > 80% predicted (Figure 1D), while 92%, 88%, and 66% had BEC < 150 cells/μL (Figure 1E)Conclusion: Clinical remission in asthma is characterized by a reduction in eosinophilic inflammation and an increase in lung function. This study characterizes a simple method of defining and predicting clinical remission in asthma patients in a real-world cohort. However, further investigations into the effects of biologics on other clinical variables affecting remission are needed.

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