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

IF 2.6 3区 医学 Q2 ALLERGY
Tugba Onalan, Fatih Colkesen, Fatma Arzu Akkus, Mehmet Emin Gerek, Filiz Sadi Aykan, Sevket Arslan
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Abstract

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.

严重哮喘生物治疗停止:影响临床缓解和医生决策因素的现实研究。
背景:现实生活中的研究已经显示了生物疗法对严重哮喘的影响。然而,在有针对性的改善后停止治疗的证据仍然有限。目的:本研究探讨重症哮喘生物制剂治疗患者临床缓解的相关因素,并探讨缓解后医生在继续或停止治疗方面的决策。方法:回顾性分析2012 - 2024年间接受生物制剂治疗至少12个月的65例重症哮喘患者。回顾了人口统计学和临床数据,以及医生报告的缓解后继续使用生物制剂的原因和停止治疗后的结果。结果:44.6%的患者获得临床缓解。患有非甾体类抗炎药物加重的呼吸系统疾病、过敏性支气管肺曲霉菌病或嗜酸性肉芽肿病合并多血管炎的患者,以及那些效果逐渐减弱的患者,在缓解后,由于医生的判断和对哮喘和共存疾病加重的担忧,没有停止使用生物制剂。缓解后继续生物治疗的决定受到鼻息肉病、间歇性使用大剂量吸入皮质类固醇、既往失败的停药和某些其他因素的影响。在13例停止生物治疗的患者中,3例因生物无反应而停止治疗,所有3例患者均患有哮喘-慢性阻塞性肺疾病重叠(ACO)。其中10例在停药前达到临床缓解。这10例患者中有1例因病情加重和症状无法控制而重新开始治疗。其余9例患者中有2例出现非严重恶化。结论:生物制剂对重度哮喘患者的缓解非常有效。实现预期目标并不需要所有患者连续使用生物制剂。注意症状的减弱可能有助于成功停药。个体化治疗计划,包括考虑合并症、调整剂量间隔和非生物治疗选择,对于停止使用生物制剂的最佳结果至关重要。
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来源期刊
CiteScore
5.70
自引率
35.70%
发文量
106
审稿时长
6-12 weeks
期刊介绍: Allergy & Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists. The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma. Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.
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