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. 2022 Mar 14;39(5):2065–2084. doi: 10.1007/s12325-022-02098-1
Expert consensus definitions for clinical remission and super-response to treatment have recently been established for patients with severe asthma.
A large percentage of patients with severe asthma continue to receive treatment with oral corticosteroids (OCS) despite updated treatment recommendations to avoid OCS whenever possible and despite the substantial morbidity and mortality associated with OCS; this continued overreliance on OCS may be due to the current clinical approach to asthma management, which has been likened to treat-to-failure, whereby therapy is sequentially increased to the maximum recommended dose when patients fail to show measurable improvements or efficacy of combination therapy.
Subgroups of patients randomized to the approved 30 mg benralizumab Q8W dose in previous randomized, phase 3 trials (SIROCCO, CALIMA, and ZONDA) were assessed to identify patients who achieved one or more composite criteria of clinical remission at 6 or 12 months: zero exacerbations; zero OCS use; Asthma Control Questionnaire-6 (ACQ-6) score < 1.5 or ≤ 0.75; and pre-bronchodilator forced expiratory volume in 1 s (FEV1) increase ≥ 100 mL.
Among those in SIROCCO and CALIMA, 14.8% (90/609) and 14.5% (85/586) met the criteria for clinical remission at 6 and 12 months, respectively, whereas 22.5% (9/40) of patients in ZONDA met the criteria for clinical remission at 6 months; across all three trials, > 86% achieved ≥ 2 components and > 54% achieved ≥ 3 remission components, demonstrating that clinically meaningful improvements were often achieved regardless of whether patients ultimately achieved the stringent, full definition of clinical remission.
Clinical remission in severe asthma can be achieved by using targeted treatments, such as benralizumab, to address eosinophils as the underlying driver of inflammation; these precision approaches represent a promising way to end the age of treat-to-failure and usher in a new era of treat-to-target, with expert consensus definitions as a benchmark for treatment success.