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

IF 2.4 Q2 RESPIRATORY SYSTEM

Respiratory investigation Pub Date : 2025-05-16 DOI:10.1016/j.resinv.2025.05.005

Shota Takahashi , Naoya Tanabe , Satoshi Marumo , Yu Hara , Yusuke Hayashi , Shinya Tsukamoto , Kyohei Morita , Chie Yoshimura , Moon Hee Hwang , Hironobu Sunadome , Atsuyasu Sato , Kota Murohashi , Takeshi Kaneko , Hisako Matsumoto , Toyohiro Hirai

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Abstract

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.

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探讨重症哮喘患者接受抗il - 4r α、抗il -5/ 5r或抗ige治疗后临床缓解的相关因素

生物制剂的最佳选择是重症哮喘患者实现临床缓解（CR）的关键。这项现实世界的研究检查了接受抗il - 4r α、抗il -5/ 5r或抗ige治疗的严重哮喘患者与CR相关的基线前生物因素。方法：这项日本多中心回顾性观察性研究纳入了连续接受抗il - 4r α、抗il -5/ 5r或抗ige治疗至少1年后肺活量测定和哮喘控制试验（ACT）数据可获得的严重哮喘患者。3域CR的定义是基于无维持性口服皮质类固醇（OCS）使用，前一年无恶化，ACT≥23。4域CR的定义标准为无OCS、无加重、ACT≥20、1 s内按百分比预测的用力呼气量≥80%。结果共纳入重症哮喘患者236例（抗il - 4r α组81例，抗il -5/ 5r组104例，抗ige组51例）。3-域和4-域的CR率分别为28 - 47%和22 - 36%。在多变量模型中，慢性鼻窦炎和较高的FeNO水平与接受抗il - 4r α治疗的患者的3结构域CR相关，但在接受抗il -5/ 5r或抗ige治疗的患者中，在调整基线OCS使用、过去一年的加重史、体重指数、性别和疾病持续时间后，与3结构域CR无关。此外，在对相同变量进行调整后，接受抗il - 4r α治疗的患者中，较高的FeNO水平与4结构域CR相关。结论抗il - 4r α治疗对伴有慢性鼻窦炎或FeNO水平基线偏高的重症哮喘患者可能有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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