Long term clinical remission on biologics: An analysis of real-world data from the UK severe asthma registry
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Authors
Redmond C.
Busby J.
Mansur A.H.
Patel M.
Patel P.H.
Pfeffer P.E.
Heaney L.G.
Rupani,H.
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Issue Date
2025
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Conference Proceedings
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Introduction 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. 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 (20-48 months) and defined as controlled asthma (ACQ6<1.5), no exacerbations in the preceding 12 months and no maintenance oral corticosteroid use (mOCS). Logistic regression and multivariate models were used to identify predictors of remission. Results At baseline, patients had high symptom burden (ACQ6 score 3.0 2.2, 3.8]), high exacerbation burden (median 5 exacerbations IQR 4, 8] in previous year) and mOCS use (49.9% of patients). Clinical remission was achieved in 25.1% of patients at first review (13.3 IQR 11.9, 17.1] months), increasing to 32.1% at long-term review (36.1 IQR 33.9, 38.9] months). Higher asthma symptom burden and presence of anxiety/depression at baseline were negatively associated with achieving long-term remission. Older age at baseline and the presence of nasal polyps increased likelihood of long-term remission. 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 (figure 1). Baseline characteristics predictive of this latter transition included elevated blood eosinophils, absence of obesity, lower symptom burden and non-reliance on mOCS. Of the 525 patients, 412 (78.5%) remained on the same biologic until long-term review. Among the 103 patients who switched biologic, 14 (13.6%) achieved remission. Conclusion In this large real-world cohort of patients with SA, there is a progressive increase in clinical remission rates over time, which is influenced by the presence of comorbidities but is largely independent of biologic switching.
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Thorax