Clinical Remission in Severe T2-High Asthma in Real Life After Anti-IgE, Anti-IL-5 and Anti-IL5R: A Potential Role for CRP as a Biomarker.

Abstract

Background: Biotherapies have transformed the management of severe asthma (SA), shifting treatment goals from disease control toward achieving clinical remission. This study aimed to evaluate the effectiveness of biotherapies in inducing remission in severe asthma and to identify baseline patient characteristics that could predict remission.

Methods: We conducted an observational, retrospective, monocentric study including severe T2-high asthmatic patients who had initiated their first biological therapy (omalizumab, mepolizumab or benralizumab) between 2006 and 2023. Clinical remission at 12 months was defined by the absence of exacerbations, no chronic oral corticosteroid use, and good symptom control (Asthma Control Test score ≥ 20 and Asthma Control Questionnaire-6 score < 1.5).

Material: Data were extracted from the registry of our asthma clinic. We included 206 patients-97 treated with omalizumab, 71 with mepolizumab, and 38 with benralizumab.

Results: Of the 206 patients, 62 (30%) achieved remission at 12 months. The mean age was 52 years, and 39% were male. Remission rates were 29% for omalizumab, 28% for mepolizumab, and 37% for benralizumab. Patients achieving remission had better baseline lung function (pre- and post-bronchodilator FEV1% predicted and FVC % predicted, p = 0.01), lower CRP levels (p = 0.01), earlier disease onset (p < 0.05), and were less likely to have a history of smoking (p < 0.01) and denied SABA and LAMA use compared to patients who did not achieve remission. Only CRP remained significant predictor after multiple logistic regression (p = 0.04).

Conclusion: Biological treatments with omalizumab, mepolizumab or benralizumab are capable of inducing clinical remission at 12 months in around one third of severe T2-high asthmatics. A low baseline CRP might be predictive of achieving remission.