Biologic treatment discontinuation in severe asthma: A real-life study on factors influencing clinical remission and physician decision-making

Background: Real-life studies have shown the effects of biologic therapies on severe asthma. However, evidence for discontinuing treatment after targeted improvement remains limited. Objective: This study investigated the factors associated with clinical remission in patients with severe asthma treated with biologics and explores physician decision-making with regard to the continuation or discontinuation of treatment after remission. Method: A retrospective analysis was conducted on 65 patients with severe asthma who received biologics for at least 12 months between 2012 and 2024. Demographic and clinical data were reviewed, alongside physician-reported reasons for continued biologic use after remission and outcomes after treatment discontinuation. Results: Clinical remission was achieved in 44.6% of the patients. Patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory disease, allergic bronchopulmonary aspergillosis, or eosinophilic granulomatosis with polyangiitis, and those with waning effect did not discontinue biologics after remission due to physician judgment and concerns about exacerbating both asthma and coexisting conditions. The decision to continue biologic therapy after remission was influenced by nasal polyposis, intermittent use of high-dose inhaled corticosteroids, previous failed cessations, and certain other factors. Of the 13 patients who discontinued biologic treatment, 3 did so due to biologic nonresponse, all 3 with asthma-chronic obstructive pulmonary disease overlap (ACO). Ten had achieved clinical remission before discontinuation. Treatment was restarted in one of these 10 patients due to exacerbations and loss of symptom control. Nonsevere exacerbations occurred in two of the remaining nine patients. Conclusion: Biologics are highly effective in achieving remission in severe asthma. Achieving the desired goals does not require continuity of biologics in all patients. Attention to waning symptoms may contribute to the success of drug discontinuation. Individualized treatment plans, including consideration of comorbidities, adjustments in dose intervals, and nonbiologic treatment options, are essential for optimal outcomes with regard to cessation of biologics.