Many Severe Asthma Patients Achieve Remission on Biologics

PHOENIX — Biologic medications sent severe asthma into remission in a substantial proportion of patients, according to a study presented here at the annual meeting of the American Academy of Allergy, Asthma & Immunology.

About 35% of 908 patients who took biologic treatments for at least 12 months were able to achieve remission status, reported Bradley Chipps, MD, medical director of respiratory therapy at Sutter Medical Center in Sacramento, California.

“In this real-world population,” Chipps said, “nearly seven in 10 patients with severe asthma who had 12 months of biologic use did not have exacerbations of require systemic corticosteroids.

“More than one in three patients achieved asthma control and met criteria for clinical remission,” he said in his oral presentation.

For his group’s CHRONICLE study, remission was defined as at least 12 months of consistent absence of asthma symptoms based on monthly Asthma Control Test scores; patient and provider agreement of disease remission; and no use of systemic corticosteroids for treatment of exacerbations of long-term disease control.

The standard definition of remission also includes lung function stabilization, Chipps said, but the database used in the study did not have consistent lung function data to include.

The patients were recruited from practices of allergists, immunologists and pulmonologists and were on FDA-approved monoclonal antibody agents primarily for treatment of severe asthma. Their outcomes were examined by the research team to see if the patients met the criteria for remission.

The first of the qualifiers — no use of systemic corticosteroids of any duration during the past year — was met by 86.2% of the patients in the study. Of the total, 67.7% were free of any exacerbation requiring steroids or hospitalization. Chipps said 38.3% of the participants achieved those first two steps and had Asthma Control Test scores that were 20 or higher, indicating asthma is well controlled, for at least half of the monthly visits.

And 318 of the 908 patients not only achieved those steps but also had agreement between the doctor and the patients that remission had been achieved.

In further analyses, characteristics associated with higher remission rates were:

• Men (36.5% vs 28.1% among women)
• White race (85.5% vs 81.2% of other patients)
• Lower body mass index (mean 31.2 with vs 33.4 without remission)
• Commercial insurance (66% rate with commercial insurance vs 59% among other patients)
• Rural residence (60% rate vs 29% among urban dwellers)

In commenting on the study, William Anderson, MD, associate program director of the allergy and immunology fellowship program at Children’s Hospital Colorado/University of Colorado in Aurora, told MedPage Today: “This study just looked at descriptions of patients but not the underlying drivers. But those patients who did well historically had markers that were associated with less disparities in health care or access to care, so that could possibly be why the rural population did better.”

“It may be because they were not having some of these inner city socioeconomic factors that are being seen with the rest of the population,” he said. “It is a question of the environment or is it the socioeconomic burden on these patients?”

Anderson noted that while the best medical facilities are usually concentrated in cities, the greatest disparity in care is also in these metropolitan areas.

Overall, in the CHRONICLE study, the patients averaged about 30 years old; some 68% had never smoked cigarettes, while 2.5% to 5% of the patients were current smokers; and about 95% of the patients were of non-Hispanic ethnicity.