The phenomenon of remission in severe asthma: potential of biologic therapy and unresolved issues of verification

Introduction. Biologics have shifted the treatment paradigm for severe asthma (SA), making clinico- functional remission a priority. However, the stability of this state and its predictors in real-world practice remain insufficiently studied.

Aim. To evaluate the frequency of sustained clinico-functional remission in SA patients and identify factors associated with long-term success.

Materials and methods. This 30-month retrospective study analyzed data from a regional registry (Sverdlovsk Region) of SA patients treated with dupilumab, mepolizumab, benralizumab, or omalizumab. 4-component (no exacerbations, OCS withdrawal, ACT control, FEV 1  stability) and 3-component (excluding FEV 1 ) remissions were evaluated in rolling intervals (4–18, 12–24, and 18–30 months). Sustained remission required continuous fulfillment of criteria at all points (months 4, 12, 18, 24, and 30).

Results. Remission frequency in rolling intervals ranged from 1.7% to 45.1%. Sustained remission was achieved by 26.3% of patients. This group was significantly younger (46.5 vs 54.3 years; p = 0.014) and non-obese (BMI 23.1 vs 29.6 kg/m²; p = 0.001). Logistic regression identified elevated BMI as an independent predictor of remission failure (AUC 0.782; 95% CI: 0.652–0.912). A trend toward higher efficacy was noted with a disease duration < 12 years (p = 0.053). The highest proportion of sustained responses occurred with dupilumab (47.6%).

Conclusions. Sustained remission is achievable in 25% of SA patients. Excess body weight and long disease duration are key barriers, highlighting the need for early biologic initiation and metabolic correction.

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