Photo Credit: Evgeniya Pavlova

Researchers gathered real-world data on biologic therapy to determine the feasibility of targeting clinical remission when treating patients with severe asthma.

Severe asthma affects about 3% to 10% of people with asthma. Current estimates suggest that approximately half of people with severe asthma have the eosinophilic subtype, which is associated with elevated eosinophil counts.

There is growing interest in targeting on-treatment clinical remission as a treatment goal, according to authors of a study published in the Journal of Allergy and Clinical Immunology: Global.

In 2020, an expert consensus developed an initial framework for remission in asthma that includes a sustained absence of significant symptoms, stabilization of lung function, patient-clinician agreement on remission, and no use of systemic corticosteroids for exacerbation treatment or maintenance therapy. Bradley Chipps, MD, and colleagues wrote that real-world data on clinical remission in patients with severe asthma are limited, which presents challenges for further refining this framework.

“Thus, the objective of this analysis was to evaluate the proportion of patients who achieve incident clinical remission with at least 12 months of biologic therapy among a large cohort of subspecialist-treated adults with severe asthma in the United States. This study further examined the characteristics of patients with severe asthma achieving versus not achieving clinical remission,” Dr. Chipps and colleagues wrote.

Study Design & Methods

The authors evaluated patients enrolled in the CHRONICLE study, a noninterventional study of US adults with severe asthma treated by allergists/immunologists or pulmonologists at 137 sites. The study included patients with subspecialist-diagnosed severe asthma for at least 12 months before enrollment who were either treated with biologics or maintenance systemic corticosteroids or had persistently uncontrolled asthma despite treatment with high-dosage inhaled corticosteroids and additional controllers.

The authors reported that their study did not influence biologic use, determined by approved indications, clinical judgment, and US health insurance reimbursement criteria.

The analysis aimed to evaluate the proportion of patients achieving clinical remission after at least 12 months of biologic treatment. The researchers defined clinical remission as:

• the absence of exacerbations and systemic corticosteroid use;
• at least 50% of Asthma Control Test (ACT) scores of 20 or more points in the latest 6 months; and
• asthma control reported by subspecialists in the latest 6 months.

Factors Tied to Severe Asthma Remission

Of the 611 evaluable patients, 79.9% had no systemic corticosteroid use for exacerbation or maintenance therapy over 12 months. Among this group, 54.0% achieved clinical remission, defined as at least 50% of their monthly ACT scores being 20 points or higher, and 46.0% had a subspecialist report indicating asthma control.

Researchers found that patients who achieved clinical remission were more likely to have commercial insurance (69.4% vs 57.0%) and were employed (63.3% vs 44.2%) compared with those who did not achieve remission (P<0.05). Additionally, patients in remission had a higher mean blood eosinophil count, IgE level, and fractional exhaled nitric oxide (FeNO) level (P<0.001). According to the authors, remission was also more common among those with a lower BMI, suggesting that metabolic factors may influence remission outcomes.

The median time from biologic initiation to remission was 30.2 months (95% CI, 25.7-33.6), with remission rates increasing from 22.3% at months 12-13 to 34.3% at months 47-48. When the alternative ACT criterion was applied, point prevalence of remission remained consistent, ranging from 21.0% at months 12-13 to 28.6% at months 47-48.

Tailored Management Needed

The researchers concluded that clinical remission is a feasible treatment goal for patients with severe asthma treated with biologics. Approximately 20% to 30% of patients achieved remission at any given 12-month interval, suggesting that clinical remission is a viable target.

Given the various patient characteristics associated with remission, the researchers emphasized the importance of personalized treatment in achieving clinical remission.

The study was limited by its reliance on clinical remission criteria rather than complete remission, as biomarker measures were not included in the analysis. Additionally, lung function was not included in the remission criteria, given the limited number of repeat lung function tests.

“Adoption of on-treatment clinical remission as a treatment goal in severe asthma might help improve long-term patient outcomes, similar to what has been achieved with treatment approaches targeting clinical remission in other chronic inflammatory diseases,” Dr. Chipps and colleagues concluded. “Ultimately, controlling symptoms and being able to maintain normal activity levels are primary long-term goals of asthma treatment in addition to risk minimization. Management of severe asthma, including targeting on-treatment clinical remission, should be personalized to patients’ needs and may include lifestyle and other nonmedication interventions.”