Comparison of clinical remission criteria for severe asthma patients receiving biologic therapy.

Background: The concept of remission on biological treatment has been suggested as a therapeutic target for patients with severe asthma, composed of 1. no chronic use of systemic steroids, 2. no exacerbations, 3. minimal symptoms, and 4. optimized lung function, for a significant time. However, the criteria for remission are not clearly defined.
Objective: Our objective was to compare different criteria for remission in subjects receiving biologicals for severe asthma.
Methods: A cross-sectional study of adult subjects who receive a stable regimen of a biological for severe asthma for at least 6-months. We compared the proportion of subjects who fulfilled different specific criteria in the four domains, as well as those who achieved different composite outcome measures of clinical remission.
Results: Of 39 subjects, 28 were females (71.8%), mean age 60.4. Twelve were current or past smokers (30.8%). Twelve had prior different biological treatment (30.8%), and 3/39 had more than one previous treatment (7.7%). Current biological included mepolizumab 12/39 (30.8%), dupilumab 11/39 (28.2%), benralizumab 10/39 (25.6%), omalizumab 5/39 (12.8%), reslizumab 1/39 (2.6%). Different specific criteria were achieved in 39-80% of subjects, being highest for no chronic steroid use and lowest for symptoms control and lung function. Overall remission was obtained by 20-41%, depending on definition, with significant variability in agreement between different sets of remission criteria (Cohen's kappa 0.33-0.89).
Conclusion: Clinical remission is achievable in real-world severe asthmatics on biological therapies. The core criteria for remission should be better defined.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ori Wand reports a relationship with GlaxoSmithKline that includes: consulting or advisory and speaking and lecture fees. Ori Wand reports a relationship with AstraZeneca that includes: consulting or advisory and speaking and lecture fees. Ori Wand reports a relationship with Boehringer Ingelheim Ltd that includes: speaking and lecture fees. Ori Wand reports a relationship with Sanofi that includes: speaking and lecture fees. Ori Wand reports a relationship with Kamada Ltd that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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