Real world clinical outcomes and remission rates among patients with severe asthma on monoclonal antibody therapy over two years

<bold>Introduction:</bold> Clinical remission has become a key goal of monoclonal antibody (MAb) therapy in severe asthma (SA). Real-world remission rates among patients are not well described, and predictive features for remission remain elusive. We explore outcomes and remission rates among SA patients on MAb therapy. <bold>Methods:</bold> Retrospective analysis of patients with SA commenced on MAb therapy from January 2013 – December 2021 who completed 24 months’ therapy. We assessed baseline characteristics and clinical outcomes at 12 and 24 months including remission rates (defined as annualised exacerbation rate [AER] = 0, maintenance oral corticosteroids [mOCS] = 0, and Asthma Control Questionnaire [ACQ] <1.5). Subgroup analyses compared those who achieved remission at 12 and 24 months with those who did not. <bold>Results:</bold> 282 patients (52.1±15.7 years, 62% female) were reviewed. 31 (11%) demonstrated remission at 12 months and 27 (10%) at 24 months. Patients who demonstrated remission at 12 and 24 months had a lower mOCS and a higher ACQ-6 at baseline; those who demonstrated remission at 24 months also had lower mOCS, lower AER, and improved ACQ/AQLQ scores at 12 months compared to those who did not. Among the 251 patients who did not demonstrate remission at 12 months, 14 (6%) developed remission at 24 months. <bold>Conclusions:</bold> Clinical remission rates were lower than in current trial literature. A proportion of patients may develop remission beyond 12 months, with AER, ACQ, and AQLQ being potential predictive markers; further work is required to characterise this cohort and identify patients who may benefit from early treatment switch.