Early Failure, Late Failure, and Sustained Response to Biologics in Severe Asthma: A Long-term, Real-world, Multicentre study

David Dacal; Eva Martinez Moragon; Vicente Plaza Moral; C. Cisneros Serrano; C. Benchimol; H. Izaguirre Flores; Silvia Sánchez Cuellar; Dolores Martínez Pitarch; María Cleofe Fernández Aracil; A. Trisán Alonso; J.C. Serrano Rebollo; Z. Vásquez Gambasica; Rocío Magdalena Díaz Campos; P. Trujillo Mulato; Inés Escribano Gimeno; Daniel Laorden; Ebymar Arismendi Núñez; Nuria Marina; Alfredo de Diego Damiá; Marta Ferrer Galván; Ignacio Jesús Dávila González; Juan Ortiz de Saracho; B. G. Cosío; Luis A. Pérez de Llano; REMOTE study group

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Early Failure, Late Failure, and Sustained Response to Biologics in Severe Asthma: A Long-term, Real-world, Multicentre study

D. Dacal Rivas ^[11] ; E. Martinez-Moragón ^[12] ; V. Plaza ^[1] ; C. Cisneros Serrano ^[13] ; C. Benchimol ^[1] ; H. Izaguirre Flores ^[14] ; S. Sánchez-Cuéllar ^[2] ; M.D. Martínez-Pitarch ^[15] ; C. Fernández Aracil ^[3] ; A. Trisán Alonso ^[4] ; J.C. Serrano Rebollo ^[16] ; Z. Vásquez Gambasica ^[5] ; R.M. Díaz Campos ^[6] ; P. Trujillo Mulato ^[17] ; I. Escribano Gimeno ^[7] ; D. Laorden ^[18] ; E. Arismendi ^[19] ; N. Marina Malanda ^[8] ; A. De Diego Damia ^[20] ; M. Ferrer Galvan ^[9] ; I. Dávila ^[10] ; J. Ortiz de Saracho Bobo ^[21] ; B.G. Cosio ^[22] ; L.A. Pérez de Llano ^[11] ; REMOTE study group
1. [1] Hospital de la Santa Creu i Sant Pau
  
  Hospital de la Santa Creu i Sant Pau
  
  Barcelona, España
2. [2] Hospital Ramón y Cajal
  
  Hospital Ramón y Cajal
  
  Madrid, España
3. [3] Instituto de Investigación Sanitaria y Biomédica de Alicante
  
  Instituto de Investigación Sanitaria y Biomédica de Alicante
  
  Alicante, España
4. [4] Hospital Universitario Puerta de Hierro
  
  Hospital Universitario Puerta de Hierro
  
  Madrid, España
5. [5] Hospital Universitario de Getafe
  
  Hospital Universitario de Getafe
  
  Getafe, España
6. [6] Hospital Universitario 12 de Octubre
  
  Hospital Universitario 12 de Octubre
  
  Madrid, España
7. [7] Hospital Infanta Sofia
  
  Hospital Infanta Sofia
  
  Madrid, España
8. [8] Instituto de Investigación Sanitaria Biobizkaia
  
  Instituto de Investigación Sanitaria Biobizkaia
  
  Barakaldo, España
9. [9] Hospital Universitario Virgen del Rocío
  
  Hospital Universitario Virgen del Rocío
  
  Sevilla, España
10. [10] Hospital Universitario de Salamanca
  
  Hospital Universitario de Salamanca
  
  Salamanca, España
11. [11] Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Lugo, Spain
12. [12] Pneumology Service, Doctor Peset University Hospital, Valencia, Spain
13. [13] Pneumology Service, La Princesa University Hospital, Instituto de investigación La Princesa, Madrid, España
14. [14] Servicio de Neumología, Complejo Hospitalario Universitario de Canarias, Las Palmas, España
15. [15] Hospital Lluís Alcanys de Xátiva, Valencia, España
16. [16] Hospital de Llerena-Zafra, España
17. [17] Instituto Nacional del Tórax, Santiago de Chile, Chile
18. [18] Department of Pulmonology, La Paz University Hospital, Madrid, Spain
19. [19] Servei de Pneumologia del Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, España
20. [20] Area de Enfermedades Respiratorias, Hospital Universitario y Politécnico La Fe, Valencia, España
21. [21] Pneumology Service, Hospital Universitario del Bierzo, Ponferrada, España
22. [22] Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa-CIBERES, Palma de Mallorca, España
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Localización: Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax ( ALAT ), ISSN 0300-2896, Vol. 61, Nº. 12 (December 2025), 2025, págs. 749-756
Idioma: inglés
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Resumen
- Objectives Only one-third of patients with severe asthma (SA) achieve a complete response to biologics. This study aims to characterize two types of failure: early (EF), occurring ≤12 months after biologic initiation, and late (LF), occurring at any time during follow-up after response has been achieved at 12 months.
  
  Methods This is a multicentre retrospective study of adults treated with the same biologic for ≥24 months. Response was defined as no severe exacerbations in the preceding 12 months, asthma control test ≥20, and no need for maintenance oral corticosteroids. Failure (EF or LF) was defined as non-achievement of any of these objectives.
  
  Results Two hundred and seventy-two patients were analysed with a mean follow-up of 46.1 ± 19.4 months. At 12 months, 97/272 were classified as PF, but 40% of them recovered response on subsequent visits (by changing inhaled therapy in 74%). Among the 175 responders at 12 months, 124 (70.8%) maintained response throughout the study period, while 51 (29.1%) experienced SF; those patients had lower FEV1 values after 12 months of biological therapy. SF reverted in 36% of cases, with inhaled therapy changes in 41.6%. FEV1 decreased by ≥100 mL in 12 of 16 cases who did not recover response after SF.
  
  Conclusion Most patients who achieve response at 12 months maintain it over time, but 29% of them suffer LF. Optimization of inhaled therapy can aid response recovery from EF or LF. Maximizing pulmonary function helps to prevent loss of response.