Pathway to Remission in Severe Asthma: Clinical Effectiveness and Key Predictors of Success with Benralizumab Therapy: A Real-Life Study

<b>Introduction:</b> Recent data indicate that approximately 10-20% of patients with severe asthma (SA) receiving benralizumab (BENRA) do not achieve the desired outcomes. Emerging evidence suggests that clinical remission (CRem) is possible with biologics, warranting investigations into predictive factors. <b>Methods:</b> In this retrospective, single-center study, we analyzed 103 SA patients treated with BENRA for 12 months. CRem was defined as meeting four criteria: no exacerbations requiring oral corticosteroids (OCSs), discontinuation of chronic OCS therapy, improvement in FEV1 ≥100 mL, and an ACQ score < 1.5. Logistic regression identified predictors of remission. <b>Results:</b> After 12 months, 33% of patients achieved CRem, while 10% discontinued treatment due to lack of improvement. BENRA reduced the annual exacerbation rate from a median of 2 to 0 (<i>p</i> < 0.0001) and eliminated OCS use in 80% of patients. Lung function improved significantly, with a +13.5% predicted increase in FEV1 (<i>p</i> < 0.0001). Asthma control also improved, with ACQ scores decreasing from 3.2 to 1.5 (<i>p</i> < 0.0001) and mini-AQLQ scores increasing from 3.4 to 5.0 (<i>p</i> < 0.0001). Key predictors of remission included baseline eosinophil count ≥740 × 10³/μL (OR = 3.91, <i>p</i> = 0.02), SA duration (OR = 0.90, <i>p</i> = 0.02), baseline quality of life (OR = 2.18, <i>p</i> = 0.04), and pre-treatment FEV1 (OR = 1.07, <i>p</i> = 0.005). The logistic regression model for these parameters showed strong predictive accuracy (AUC = 0.855, 95% CI 0.78-0.93). Importantly, the SA phase, rather than total asthma duration, was the critical factor, with each additional year reducing the odds of remission by ~10%. <b>Conclusion:</b> Clinical remission is a realistic goal in severe asthma, and early initiation of biologic therapy is vital for improving remission rates and long-term outcomes.