פרס פוסטר מצטיין לד"ר אורי וונד

Clinical remission of severe asthma on biological therapies: Comparison of different criteria sets

Ori Wand MD¹, Anna Breslavsky MD¹, Ahsen Al Qaied MD¹, Philip Tsenter MD¹, Nikita Mukaseev MD¹, Mohamed Alamor MD¹, Keren Cohen-Hagai MD²

¹ Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, Israel, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

² Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel,  and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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.