Early Biomarker Trajectories After Biologic Initiation as Predictors of Remission in Severe Asthma
DOI:
https://doi.org/10.61919/qkgw8x23Keywords:
asthma; biological products; biomarkers; eosinophils; fractional exhaled nitric oxide; remission induction; retrospective studies.Abstract
Background: Severe asthma remains difficult to control in a substantial proportion of patients despite biologic therapy, and clinicians lack validated early indicators of long-term remission. Objective biomarker trajectories may provide earlier prognostic information than symptom response alone. Objective: To determine whether early changes in blood eosinophils, fractional exhaled nitric oxide, and asthma symptom scores during the first 12 weeks after biologic initiation predict 12-month clinical remission in adults with severe asthma. Methods: This retrospective cohort study included 102 adults with severe asthma who initiated first-line biologic therapy between January 2021 and December 2022 at a tertiary care hospital in the Islamabad-Rawalpindi region, with follow-up reviewed through December 2023. Early biomarker and symptom trajectories were assessed at weeks 4, 8, and 12. Clinical remission at 12 months was defined as no exacerbations, no maintenance oral corticosteroid use, and controlled symptoms. Multivariable logistic regression adjusted for age, sex, baseline biomarker values, biologic type, and baseline oral corticosteroid use. Results: Clinical remission was achieved by 38 patients (37.3%). Week 8 FeNO reduction was the strongest independent predictor of remission (aOR 1.92 per 10% reduction, 95% CI 1.41–2.61, p<0.001), followed by week 4 eosinophil reduction (aOR 1.41 per 10% reduction, 95% CI 1.18–1.68, p=0.002). Week 8 symptom-score improvement did not remain independently significant after biomarker adjustment (p=0.21). The combined biomarker model showed good discrimination (c-statistic 0.84, 95% CI 0.76–0.92). Conclusion: Early FeNO and eosinophil reductions were independently associated with 12-month remission after biologic initiation in severe asthma. These findings support early biomarker-based prognostic assessment but require prospective validation before use in treatment-switching decisions
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Copyright (c) 2025 Muhammad Hassan Raza, Fnu Neha, Ekta Bai, Ravi Kumar, Akshy Kumar, Shaikh Khalid Muhammad (Author)
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