Clinical characteristics impacting clinical remission attainment in REALITI-A

<bold>Background:</bold> Clinical remission (CR) is an ambitious goal of asthma management. <bold>Aims and Objectives:</bold> This post hoc analysis of REALITI-A data analysed clinical factors that may impact CR in adults with severe asthma. <bold>Methods:</bold> This 2-year, observational, single-arm, real-world prospective study enrolled adult patients (pts) with severe asthma who were newly prescribed mepolizumab. This analysis defined CR as fulfilment of 3 criteria: no exacerbations throughout the study, no maintenance oral corticosteroid (mOCS) use 28 days before Month 24 and an ACQ-5 score <1 at Month 24. Prediction of CR attainment at Month 24 was evaluated using a single logistic regression model with baseline covariates: mOCS use (yes/no), clinically significant exacerbations (CSEs) pre‑enrolment (≥4/<4), ACQ-5 score (≥2/<2), nasal polyps/depression or anxiety/gastroesophageal reflux disease at screening (yes/no), FEV₁ (<60%/≥60%), and BMI (≥30/<25). <bold>Results:</bold> Of the 822 pts enrolled, 81 had available data, of which 30 (37%) achieved CR at Month 24. Achieving CR was significantly less likely with baseline mOCS usage (odds ratio [OR] [95% CI]: 0.11[0.02,0.51],p=0.0049), occurrence of ≥4 CSEs pre‑enrolment (0.24[0.07,0.87],p=0.0294), ACQ-5 score ≥2 (0.06[0.01,0.39],p=0.0027], and BMI ≥30 (0.11[0.02,0.78],p=0.0275). <bold>Conclusions:</bold> Despite the small subset of patients yielding a potential limitation as selection bias, CR with mepolizumab was achievable in 1 in 3 pts with severe asthma, but its attainment might significantly decrease with higher disease severity (in line with previous findings), suggesting the potential benefits of initiating treatment before pts reach advanced stages of asthma severity. <bold>Funding:</bold> GSK (204710)