An expert consensus framework for asthma remission as a treatment goal

Abstract

With novel therapies in development, there is an opportunity to consider asthma remission as a treatment goal. In this Rostrum, we present a generalized framework for clinical and complete remission in asthma, on and off treatment, developed on the basis of medical literature and expert consensus. A modified Delphi survey approach was used to ascertain expert consensus on core components of asthma remission as a treatment target. Phase 1 identified other chronic inflammatory diseases with remission definitions. Phase 2 evaluated components of those definitions as well as published definitions of spontaneous asthma remission. Phase 3 evaluated a remission framework created using consensus findings. Clinical remission comprised 12 or more months with (1) absence of significant symptoms by validated instrument, (2) lung function optimization/ stabilization, (3) patient/provider agreement regarding remission, and (4) no use of systemic corticosteroids. Complete remission was defined as clinical remission plus objective resolution of asthma-related inflammation and, if appropriate, negative bronchial hyperresponsiveness. Remission off treatment required no asthma treatment for 12 or more months. The proposed framework is a first step toward developing asthma remission as a treatment target and should be refined through future research, patient input, and clinical study. (J

EAACI Biologicals Guidelines—Recommendations for severe asthma

“…The “holy Grail” for the use of biologicals in severe asthma is to validate their disease‐modifying potential 181 . If this proves to be true, we might consider a future potential role for biologicals in mild asthma to prevent the evolution towards severe cases or for the primary prevention of asthma in high‐risk individuals.…”

Precision Medicine for Paediatric Severe Asthma: Current Status and Future Direction

“…The growing interest in precision medicine prompted further investigations into the potential use of anti-IL5 therapy in patients with a known treatable trait, ie, evidence of eosinophilic asthma. 95 Two subsequent small studies, which included only patients with a history of recurrent asthma attacks and raised sputum eosinophils, found a substantial reduction by 43% in asthma attacks over 12 months in the mepolizumab arm 96 and a reduction in daily OCS. 97 These results have since been replicated in several large Phase 3 trials.…”

“…[98][99][100][101] In adults with severe eosinophilic asthma, there was a reduction in asthma attacks, 98,102 an improvement in quality of life, 101 and a reduction in the need for OCS. 100 The efficacy of mepolizumab is sustained over the whole 4-week dosing period 95 and is proportional to the baseline blood eosinophil count. 98 Patient reported quality of life indices were no different between the mepolizumab and placebo groups and there was a limited impact on lung function.…”

Health-Related Quality of Life and Productivity Among US Patients with Severe Asthma

“…Clinical remission was defined consistent with the recent framework by Menzies-Gow et al using available study endpoints: During the latest 12 months of biologic use, the absence of SCS use (for maintenance or acute exacerbation treatment), all (and at least 2) patient Asthma Control Test scores ≥20, and confirmation from the patient (via the Asthma Control Test) and HCP that the patient’s asthma was controlled in the most recent time interval. 21 …”