Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients
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McDonald, VM
Stevens, S
Harvey, ES
Baraket, M
Bardin, P
Bowden, JJ
Bowler, S
Chien, J
Chung, LP
Gillman, A
Hew, M
Hodge, S
James, A
Sivakumaran, P
et al.
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Abstract
Background: Asthma remission has emerged as a potential treatment goal. This study evaluated the effectiveness of two biologics (mepolizumab/omalizumab) in achieving asthma remission. Methods: This observational study included 453 severe asthma patients (41% male; mean age ± SD 55.7 ± 14.7 years) from two real-world drug registries: the Australian Mepolizumab Registry and the Australian Xolair Registry. The composite outcome clinical remission was defined as zero exacerbations and zero oral corticosteroids during the previous 6 months assessed at 12 months and 5-item Asthma Control Questionnaire (ACQ-5) ≤1 at 12 months. We also assessed clinical remission plus optimization (post-bronchodilator FEV1 ≥80%) or stabilization (post-bronchodilator FEV1 not greater than 5% decline from baseline) of lung function at 12 months. Sensitivity analyses explored various cut-offs of ACQ-5/FEV1 scores. The predictors of clinical remission were identified. Results: 29.3% (73/249) of AMR and 22.8% (37/162) of AXR cohort met the criteria for clinical remission. When lung function criteria were added, the remission rates were reduced to 25.2% and 19.1%, respectively. Sensitivity analyses identified that the remission rate ranged between 18.1% and 34.9% in the AMR cohort and 10.6% and 27.2% in the AXR cohort. Better lung function, lower body mass index, mild disease and absence of comorbidities such as obesity, depression and osteoporosis predicted the odds of achieving clinical remission. Conclusion: Biologic treatment with mepolizumab or omalizumab for severe asthma-induced asthma remission in a subgroup of patients. Remission on treatment may be an achievable treatment target and future studies should consider remission as an outcome measure.
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Allergy: European Journal of Allergy and Clinical Immunology
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© 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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Respiratory diseases
Immunology
asthma
mepolizumab
omalizumab
remission
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Citation
Thomas, D; McDonald, VM; Stevens, S; Harvey, ES; Baraket, M; Bardin, P; Bowden, JJ; Bowler, S; Chien, J; Chung, LP; Gillman, A; Hew, M; Hodge, S; James, A; Jenkins, C; Katelaris, CH; Katsoulotos, GP; Langton, D; Lee, J; Marks, G; Peters, M; Radhakrishna, N; Reynolds, PN; Rimmer, J; Sivakumaran, P; Upham, JW; Wark, P; Yang, IA; Gibson, PG, Biologics (mepolizumab and omalizumab) induced remission in severe asthma patients, Allergy: European Journal of Allergy and Clinical Immunology, 2023