Defining and identifying predictors of severe asthma clinical remission following biologic therapy

Azza Omar
Raja Perempuan Zainab II Hospital, Kota Bahru, Kelantan, Malaysia

Biologic therapies have transformed the treatment landscape for severe asthma, with growing recognition that clinical remission—rather than symptom control alone—can be a realistic therapeutic goal. However, defining remission and identifying which patients are most likely to achieve it remains a critical need in clinical practice.

The clinical remission in severe asthma, typically characterized by the absence of exacerbations, withdrawal of maintenance oral corticosteroids, improved lung function, and well-controlled symptoms. Drawing from key clinical trials and real-world data—including the SHAMAL, XPORT, and ANDHI studies—we highlight remission rates ranging from 10% to 30%, depending on the biologic agent and remission criteria used.

To identify important predictors of remission across four domains: demographic (e.g., younger age, non-smoking), clinical (shorter disease duration, absence of fixed obstruction), biomarker-based (e.g., high blood eosinophils, elevated FeNO), and treatment-related factors (early biologic initiation, adherence). Evidence suggests that upstream biologics like tezepelumab may offer broader remission potential due to their agnostic biomarker profile.

Recognizing and applying these predictors can support a precision medicine approach—selecting the right biologic for the right patient, with remission as the guiding target. Future efforts should focus on unified definitions and prospective validation of predictive models