New study provides insight on clinical remission in severe asthma patients treated with biologics

Clinical remission (a state of minimal disease activity) is achievable for some patients with severe asthma using biologic therapies. However, the study, published in The Lancet Respiratory Medicine, suggests that for some patients, significant barriers remain—especially for those with long disease duration, severe symptoms, or specific comorbidities such as depression and obesity.

Whilst asthma experts have increasingly prioritised clinical remission as a treatment target, a lack of standardisation in defining remission has led to inconsistent data. To combat this, the researchers conducted an in-depth review of existing studies to determine rates of clinical remission, associated definitions, and identify potential clinical factors linked to remission in patients receiving biologic therapies for asthma.

Clinical remission has emerged as an important treatment goal in severe asthma over the last three years. Although there’s broad agreement that patients in clinical remission should not be receiving oral steroids, other components of the definition varied dramatically. If it is to be a useful outcome for health care and research purposes in the future, the severe asthma community must now agree on a standardised definition.

Dr John Busby, Senior Lecturer in Medical Statistics at Queen’s University Belfast

The research team reviewed over 3,000 studies and found 25 that met their inclusion criteria. Across these, 68 definitions of clinical remission were identified, revealing substantial variation in how remission is defined, especially regarding lung function and symptom control.

In light of this inconsistency, the researchers focused on two specific definitions for their analysis: one incorporating three components (oral corticosteroid use, exacerbations, and symptom burden) and another adding a fourth component (lung function). Their findings showed that about 38% of patients met the criteria for remission under the three-component definition, while 30% achieved remission using the more stringent four-component criteria.

The research team found that several factors were associated with reduced remission rates. Pulmonary factors, including low forced expiratory volume (FEV1) and high symptom burden, were found to be significant hurdles. Non-pulmonary factors, particularly the presence of depression and obesity, also played a role. Patients with longer asthma histories and those reliant on maintenance corticosteroids also showed lower remission rates.

These findings highlight the need for consensus-driven definitions of clinical remission, as well as early intervention strategies and individualised treatment plans. 

“Our study,” Dr Busby adds, “shows that clinical remission is an achievable treatment goal for a substantial minority of patients with severe asthma. We hope these results will provide a platform upon which to build standardised definitions and aid the design of more effective treatment strategies for patients suffering with what can be a very debilitating disease.”

The study was supported by Health Data Research UK as part of the Inflammation and Immunity Driver Programme. 

Read the paper here: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(24)00293-5/fulltext