April 2024
In a real-world study, most patients with severe asthma had good response to biologics

And 24% achieved clinical remission. 

Asthma biologics are an effective, but very expensive, treatment for patients with severe asthma. Danish researchers used a national registry to see how many patients achieve ‘remission’ and which patient characteristics predict better responses.

About 500 patients who were starting biologic agents (targeting IgE, interleukin-5 or IL-4/13) for severe asthma were included. Clinical response was defined as a 50% or greater reduction in annualised exacerbation rate and 50% or greater reduction in maintenance oral corticosteroid doses. Clinical remission was defined as no exacerbations, no maintenance oral corticosteroids, normal lung function and good asthma control based on questionnaires.

After 12 months, 79% of patients had clinical response, and 24% of those patients achieved clinical remission. Nonresponders were more likely to be obese and to have been taking maintenance oral corticosteroids at baseline. Responders were more likely to be male and to have better baseline lung function, higher levels of type 2 markers of inflammation (i.e. eosinophil counts, IgE levels and exhaled nitric oxide levels), shorter duration of disease and more acute exacerbations before starting biologics. 

Comment: Six biologic agents currently are available in the USA. Most primary care providers do not start biologics in their patients with asthma, but knowing this information will help with counselling. Most patients have good responses to biologics, and about one-fifth will achieve complete control of their asthma. Because these medications are very expensive, understanding the characteristics that predict response is important.

David J. Amrol, MD, Associate Professor of Clinical Internal Medicine, Director of the Division of Allergy and Immunology, University of South Carolina School of Medicine, Columbia, USA.

Hansen S, et al. Clinical response and remission in patients with severe asthma treated with biologic therapies. Chest 2024; 165: 253-266.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.