Exploring factors associated with clinical remission in patients with severe asthma receiving anti-IL-4Rα, anti-IL-5/5R, or anti-IgE treatment

BACKGROUND: The optimal selection of biologics is critical for achieving clinical remission (CR) in patients with severe asthma. This real-world study examined baseline prebiologic factors associated with CR in patients with severe asthma receiving anti-IL-4Rα, anti-IL-5/5R, or anti-IgE treatment. METHODS: This Japanese multicenter retrospective observational study included consecutive patients with severe asthma whose spirometry and asthma control test (ACT) data were available after at least 1 year of anti-IL-4Rα, anti-IL-5/5R, or anti-IgE treatment. The 3-domain CR was defined based on no maintenance oral corticosteroid (OCS) use, no exacerbation in the previous year, and ACT ≥23. The 4-domain CR was defined based on no OCS, no exacerbation, ACT ≥20, and percentage-predicted forced expiratory volume in 1 s ≥ 80 %. RESULTS: A total of 236 patients with severe asthma were included (n = 81, 104, and 51 for the anti-IL-4Rα, anti-IL-5/5R, and anti-IgE treatment groups, respectively). The rates of 3- and 4-domain CR were 28-47 % and 22-36 %, respectively. In the multivariate models, the presence of chronic rhinosinusitis and higher FeNO levels were associated with 3-domain CR in patients receiving anti-IL-4Rα treatment but not in those receiving anti-IL-5/5R or anti-IgE treatment after adjusting for baseline OCS use, past-year exacerbation history, body mass index, sex, and disease duration. Moreover, higher FeNO levels were associated with 4-domain CR in patients receiving anti-IL-4Rα treatment after adjustment for the same variables. CONCLUSION: Anti-IL-4Rα treatment may be effective for patients with severe asthma who have chronic rhinosinusitis or high FeNO levels at baseline.