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The following is a summary of “Clinical remission attainment, definitions, and correlates among patients with severe asthma treated with biologics: a systematic review and meta-analysis,” published in the January 2025 issue of Pulmonology by Shackleford et al.
Clinical remission was recognized as an essential treatment goal in severe asthma, but studies reported variable attainment due to differences in populations, definitions, and methods.
Researchers conducted a retrospective study to analyze clinical remission attainment, definitions, and correlations in patients with severe asthma treated with biologics.
They searched Web of Science, Embase, and MEDLINE for studies published until June 13, 2024, using the keywords “asthma” and “remission.” Only English-language peer-reviewed studies reporting clinical remission rates in patients with severe asthma treated with biologics were included, without restrictions on study design; 2 reviewers (AS and CR) independently screened the studies, with disagreements resolved by a third reviewer (JB). Data on study characteristics, clinical remission definitions, attainment, and correlates were extracted by 2 reviewers (AS and CR) using Covidence. Clinical remission was defined with a three-component definition (maintenance oral corticosteroids, exacerbations, asthma symptom burden) and a four-component definition (including lung function). DerSimonian-Laird random-effects models assessed the rate of clinical remission and correlated it with heterogeneity, analyzed using the I2 statistic.
The results showed 3,014 studies were initially identified, with 1,812 screened and 25 studies (28 analyses) included. A total of 68 clinical remission definitions were identified, with 48 unique definitions and minimal consensus across studies, especially regarding symptoms and lung function. The three-component clinical remission definition was used in 8 analyses, while 25 used the four-component definition. The pooled clinical remission rate was 38% (95% CI 29–47; I2 =93%) for the three-component definition and 30% (27–34; I2=83%) for the four-component definition. Several pulmonary factors correlated with lower remission rates, including worse FEV1 (odds ratio 0.09 [95% CI 0.01–0.92]; I2 =87%), worse asthma symptoms (0.23 [0.17–0.33]; I2 =0%), longer asthma duration (0.49 [0.32–0.76]; I2 =22%), and use of maintenance oral corticosteroids (0.57 [0.40–0.79]; I2 =49%). Comorbidities such as depression (0.38 [0.23–0.61]; I2 =6%) and obesity (0.41 [0.31–0.54]; I2 =0%) were significant non-pulmonary barriers to clinical remission.
Investigators concluded the clinical remission was achievable in a minority of individuals with severe asthma treated with biologics, but varied definitions and significant barriers such as longer disease duration, higher severity, and comorbidities indicated a need for consensus-driven definitions and early, effective interventions to improve outcomes.
Source: thelancet.com/journals/lanres/article/PIIS2213-2600(24)00293-5/fulltext
