Achievement rate and predictive factors of the deep remission to biologics in severe asthma

Oishi, K; Hamada, Kazuki; Murata, Youichirou; Yamaji, Yoshikazu; Asami, Maki; Edakuni, Nobutaka; Hirano, Tsunahiko; MATSUNAGA, Kazuto

doi:10.1183/13993003.congress-2022.4401

Cited by 5 publications

(9 citation statements)

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“…The reported remission rate ranged between 15% and 38% in these studies. In addition, a small outlier study reported a remission rate of 69% 7 . The observed remission rate in our study falls within this range.…”

Section: Discussionsupporting

confidence: 84%

“…A handful of recent studies ( N = 7) have explored the remission rate induced by various biologics 8–12,16 . These studies evaluated several biologics concurrently ( N = 4), 7,9,12,16 or a single agent such as mepolizumab‐induced remission 11 and benralizumab‐induced remission 8 . A post hoc analysis evaluated the efficacy of benralizumab in achieving clinical remission using data from three phase‐III clinical trial datasets 10 (SIROCCO, 17 CALIMA, 17 ZONDA 18 ).…”

Section: Discussionmentioning

confidence: 99%

“…A post hoc analysis evaluated the efficacy of benralizumab in achieving clinical remission using data from three phase‐III clinical trial datasets 10 (SIROCCO, 17 CALIMA, 17 ZONDA 18 ). Three of the seven studies that report on biologic‐induced asthma remission were small, including less than 55 participants 7–9 . The studies used a wide range of definitions including various exacerbation/symptom/OCS criteria, biomarkers and cut‐offs.…”

Section: Discussionmentioning

confidence: 99%

“…In response, researchers are racing to publish remission data on biologics. A few recent small studies, 7–9 a secondary analysis of a clinical trial dataset 10 and two recent observational studies 11,12 have evaluated the efficacy of various biologics in achieving remission. All these studies used different definitions and various biomarker cut‐off points to identify remission.…”

Section: Introductionmentioning

confidence: 99%

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Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Thomas,

McDonald,

Stevens

et al. 2023

Allergy

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BackgroundAsthma remission has emerged as a potential treatment goal. This study evaluated the effectiveness of two biologics (mepolizumab/omalizumab) in achieving asthma remission.MethodsThis observational study included 453 severe asthma patients (41% male; mean age ± SD 55.7 ± 14.7 years) from two real‐world drug registries: the Australian Mepolizumab Registry and the Australian Xolair Registry. The composite outcome clinical remission was defined as zero exacerbations and zero oral corticosteroids during the previous 6 months assessed at 12 months and 5‐item Asthma Control Questionnaire (ACQ‐5) ≤1 at 12 months. We also assessed clinical remission plus optimization (post‐bronchodilator FEV1 ≥80%) or stabilization (post‐bronchodilator FEV1 not greater than 5% decline from baseline) of lung function at 12 months. Sensitivity analyses explored various cut‐offs of ACQ‐5/FEV1 scores. The predictors of clinical remission were identified.Results29.3% (73/249) of AMR and 22.8% (37/162) of AXR cohort met the criteria for clinical remission. When lung function criteria were added, the remission rates were reduced to 25.2% and 19.1%, respectively. Sensitivity analyses identified that the remission rate ranged between 18.1% and 34.9% in the AMR cohort and 10.6% and 27.2% in the AXR cohort. Better lung function, lower body mass index, mild disease and absence of comorbidities such as obesity, depression and osteoporosis predicted the odds of achieving clinical remission.ConclusionBiologic treatment with mepolizumab or omalizumab for severe asthma‐induced asthma remission in a subgroup of patients. Remission on treatment may be an achievable treatment target and future studies should consider remission as an outcome measure.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Thomas,

McDonald,

Stevens

et al. 2023

Allergy

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“…However, a small percentage experience therapeutic failure, even with both ICS and oral corticosteroids (OCS), due to mechanisms such as IL-5 and IL-13 oversecretion, histone deacetylase down-regulation, or glucocorticoid receptor impairment [12][13][14]. Current guidelines recommend add-on biological therapy using monoclonal antibodies like omalizumab (anti-IgE), mepolizumab or reslizumab (anti-IL-5), benralizumab (IL-5 receptor blocker), and dupilumab (dual IL-4/IL-13 receptor antagonist) to improve control of difficult-to-treat asthma [6, [15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

The Effects of Benralizumab on Lung Volumes and Airway Resistance in Severe Eosinophilic Asthma: A Real-World Study

Madeira Gerardo,

da Silva Alves,

Gomes

et al. 2024

Cureus

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Introduction: Add-on biological monoclonal antibodies such as benralizumab (anti-IL-5Ra) are recommended by international guidelines to reduce exacerbations in severe eosinophilic asthma (SEA). However, few studies have assessed the impact of these therapies on lung function-related outcomes. Our goal was to evaluate the effectiveness of benralizumab on lung function, including lung volumes and airway resistance, in SEA patients in Portugal.Methods: This was a real-world, observational, prospective, multicentric study including adult patients diagnosed with SEA (January-June 2023). Spirometry and plethysmography were performed at baseline (T0) and after six months of treatment (T6) with benralizumab to assess: total lung capacity (TLC), residual volume (RV), forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), mean forced expiratory flow between 25% and 75% of FVC (mFEF-25/75), intrathoracic gas volume (ITGV), and respiratory airway resistance (Raw). Descriptive statistics (with categorical variables described as frequencies and continuous values as mean and standard deviation (SD)) and paired t-test and Cohen's d effect size were calculated (analyses performed in StataCorp v.15.1; StataCorp LLC, TX, USA).Results: Overall, 30 SEA patients were evaluated, mostly women (n=18, 60.0%), with atopy (n=22, 73.3%), a mean age of 58.4 years (SD 11.7), and assisted by pulmonology (n=19, 63.3%) or immunology-allergology (n=11, 36.7%) services. Mean eosinophilia at baseline was 1103.57 cells/mcL (SD 604.88; minimummaximum 460-2400); after the use of benralizumab, the count dropped to zero. After six months of treatment, a significant increase (p<0.0001) in FVC (15.3%), FEV 1 (22.6%), and mFEF-25/75 (17.7%) were observed from baseline (Cohen's d between 0.78 and 1.11). ITGV, RV, RV/TLC, and Raw significantly decreased (p<0.0001) during the study period (-17.3%, -29.7%, -8.9%, and -100.6%, respectively) (Cohen's d between -0.79 and -1.06). No differences in TLC were obtained (p=0.173). No differences between sexes were observed for any measure. Patients with more significant eosinophilia (>900 cells/mcL count; n=15) presented better responses in FEV 1 (p=0.001) and mFEF-25/75 (p=0.007).Conclusions: A notable eosinophil depletion with add-on benralizumab led to significant improvements in SEA patients' respiratory function (static lung volumes and airway resistance) in real-world settings after six months. The significant deflating effect of benralizumab on patients' hyperinflated lungs led to enhanced expiratory flow (increased FEV 1 and mFEF-25/75) and air trapping (decreased RV/TLC), suggesting this antibody improves bronchial obstruction, lung hyperinflation, and airway resistance. Further studies in a larger population are required to confirm these findings.

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Clinical remission in severe asthma: lights and shadows on an ambitious goal

Pelaia,

Zannoni,

Paoletti

et al. 2024

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review The aim of this study was Describe the latest evidence related to the concept of clinical remission in patients with severe asthma, focusing on the lights and shadows of this concept. Recent findings The idea of clinical remission in severe asthma patients brings about a significant shift in the way asthma is treated and managed. Although there has yet to be unanimous agreement among various scientific societies on the precise definition, this concept can be extremely useful in advancing the treatment of the disease. Summary Asthma is a common respiratory condition that affects more than 300 million people globally. It has variable symptoms and severity levels, with about 10% of patients experiencing severe asthma. While there have been advancements in treatment, severe asthma poses significant challenges. Recent approaches have focused on achieving clinical remission, which goes beyond symptom control to address underlying inflammation and biological processes. Clinical remission criteria include the absence of symptoms, reduced medication usage, and normalized inflammatory markers. Various biologic therapies show promise, with some patients achieving remission. However, remission's definition varies globally, hindering standardization and a valid comparison. Standardizing remission criteria and refining predictive factors are crucial for effective asthma management. Overall, achieving clinical remission offers hope for improved long-term outcomes in severe asthma patients.

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Achievement rate and predictive factors of the deep remission to biologics in severe asthma

Cited by 5 publications

References 0 publications

Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients

The Effects of Benralizumab on Lung Volumes and Airway Resistance in Severe Eosinophilic Asthma: A Real-World Study

Clinical remission in severe asthma: lights and shadows on an ambitious goal

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