Clinical Remission in Severe T2 high Asthma : A real-word analysis with Omalizumab, Mepolizumab and Benralizumab.

<bold>Introduction:</bold> The use of biotherapies has revolutionized the management of severe asthma. From disease control, the goal of asthma treatment is evolving towards achieving remission. <bold>Research questions:</bold> Are biotherapies capable of inducing clinical remission in severe asthma in real life? Are the initial characteristics of patients predictive of remission? <bold>Methods:</bold> We conducted an observational, retrospective, monocentric study including 208 severe T2 high asthmatics who received their first biological treatment. Our cohort included 97 patients treated with omalizumab, 72 with mepolizumab and 39 with benralizumab. Remission was defined by the absence of exacerbation, no chronic treatment with oral corticosteroids and a good symptomatic control defined by an Asthma Control Test score ≥ 20 and an Asthma Control Questionnaire ACQ-6 score <1.5. Patients who met all criteria after 12 months of treatment were considered to be in remission. <bold>Results:</bold> Among the 208 patients, 66 achieved remission (32%) at 12 months. The remission rate varied from 29% for omalizumab and mepolizumab to 44% for benralizumab. Overall, those achieving remission had a greater pre and post FEV1 % predicted (p<0.01 and p<0.05 respectively) and lower baseline CRP levels before biologic initiation (p<0.01). No statistically significant differences were found for classical baseline T2 biomarkers including blood eosinophils and FeNO even if there was a trend for the latter (p=0.07). <bold>Conclusion:</bold> Biological treatment with omalizumab, mepolizumab or benralizumab in severe asthma is capable of inducing remission in around a third of patients. Baseline spirometry and CRP levels may help in predicting remission.