D2.105 - Clinical remission of severe asthma: 5-year follow-up

Patients with severe asthma (SA) are treated by high dose of ICS/LABA±tiotropium±ALTR±oral corticosteroids (OCS)±biologics. The aim of this study was to assess the rate SA clinical remission during 5-year follow-up in a real clinical practice.

We examined 129 outpatients (29% male, aged 18-81 yr, mean age 55 yrs) with SA: group 1 (n=85) was treated with high dose of ICS/LABA±tiotropium±ALTR±OCS and group 2 (n=44) received additional biologics (omalizumab – 9 pts, mepolizumab – 8 pts, benralizumab -11 pts and dupilumab – 16 pts). Patients were prospectively followed up for 5 years in a single secondary care center and every year criteria of clinical remission were evaluated: lack of SA exacerbations and OCS use, ACQ-5<1.5 and FEV₁≥80% or increase of FEV₁≥100 ml compared to baseline.

At baseline 64% of patients with SA were atopic, 22% had aspirin-induced asthma and 21% were steroid-dependent, 28% had concomitant COPD, fixed airway obstruction was diagnosed in 79%. Patients experienced 2 or more exacerbations per year, had low mean FEV₁ (53% pred.) and ACQ-5≥1.5 in 89% of cases. Current smokers were 22% of patients and 26% were former smokers.  

In group 2 patients were younger (51 vs 58 yrs, p<0.01), with longer duration of asthma (21 vs 17 yrs, p<0.05), more often steroid-dependent (34% vs 14%, p<0.01) and had more exacerbations during previous year (2.7 vs 1.8, p<0.001) compared with group 1. After 1 year of treatment all 4 clinical remission criteria were achieved in 8% in group 1 and in 18% in group 2 (p>0.05), after 2 year – in 12% and 16% of cases (p>0.05), after 3 year – in 6% and 23% (p<0.01), after 4 year – in 5% and 16% (p<0.05), after 5 year – 7% and 20% (p<0.05).

During 5-year follow up rates of clinical remission in severe asthma were higher in patients received biologics compared to conventional therapy.