Resumen de 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
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.
