TY - JOUR
T1 - Unlocking asthma remission
T2 - key insights from an expert roundtable discussion
AU - Thomas, Dennis
AU - Lewthwaite, Hayley
AU - Gibson, Peter G.
AU - Majellano, Eleanor
AU - Clark, Vanessa
AU - Fricker, Michael
AU - Hamada, Yuto
AU - Anderson, Gary P.
AU - Backer, Vibeke
AU - Bardin, Philip
AU - Beasley, Richard
AU - Chien, Jimmy
AU - Farah, Claude S.
AU - Harrington, John
AU - Harvey, Erin
AU - Hew, Mark
AU - Holland, Anne E.
AU - Jenkins, Christine
AU - Katelaris, Constance H.
AU - Katsoulotos, Gregory
AU - Murray, Kirsty
AU - Peters, Matthew
AU - Thomas, Rejoy
AU - Tonga, Katrina
AU - Upham, John W.
AU - Wark, Peter
AU - McDonald, Vanessa M.
PY - 2025/6
Y1 - 2025/6
N2 - Treatment targets in severe asthma have evolved towards a remission-focused paradigm guided by precision medicine. This novel concept requires a shift from evaluating the efficacy of therapies based on a single outcome at a single time point to an outcome that captures the complexity of asthma remission involving several domains assessed over a sustained period. Since the concept is still emerging, multiple definitions have been proposed, ranging from symptom control and exacerbation-free to resolution of underlying pathobiology, with varying rigour in each parameter. Understanding the strengths and weaknesses of the current construct is needed to progress further. We conducted a roundtable discussion with 27 asthma experts to address this issue, and discussions were narratively synthesised and summarised. The participants observed that between one in three and one in five people treated with targeted biological therapies or macrolides experience low disease activity over a sustained period. They unanimously agreed that labelling the attained clinical state as clinical remission is useful as a clinical (e.g., facilitating a treat-to-target approach), policy (e.g., widening eligibility criteria for biologics), and scientific (e.g., a path to understanding cure) tool. Current remission rates vary significantly due to definition variability. When assessing remission, it is essential to consider confounding factors (e.g., steroid use for adrenal insufficiency). More research is required to reach an acceptable definition, and including the patient's voice in such research is essential. In conclusion, the concept of treatment-induced clinical remission is possible and valuable in asthma. However, further refinement of the definition is required. (Figure presented.).
AB - Treatment targets in severe asthma have evolved towards a remission-focused paradigm guided by precision medicine. This novel concept requires a shift from evaluating the efficacy of therapies based on a single outcome at a single time point to an outcome that captures the complexity of asthma remission involving several domains assessed over a sustained period. Since the concept is still emerging, multiple definitions have been proposed, ranging from symptom control and exacerbation-free to resolution of underlying pathobiology, with varying rigour in each parameter. Understanding the strengths and weaknesses of the current construct is needed to progress further. We conducted a roundtable discussion with 27 asthma experts to address this issue, and discussions were narratively synthesised and summarised. The participants observed that between one in three and one in five people treated with targeted biological therapies or macrolides experience low disease activity over a sustained period. They unanimously agreed that labelling the attained clinical state as clinical remission is useful as a clinical (e.g., facilitating a treat-to-target approach), policy (e.g., widening eligibility criteria for biologics), and scientific (e.g., a path to understanding cure) tool. Current remission rates vary significantly due to definition variability. When assessing remission, it is essential to consider confounding factors (e.g., steroid use for adrenal insufficiency). More research is required to reach an acceptable definition, and including the patient's voice in such research is essential. In conclusion, the concept of treatment-induced clinical remission is possible and valuable in asthma. However, further refinement of the definition is required. (Figure presented.).
KW - asthma
KW - remission
KW - roundtable
UR - http://www.scopus.com/inward/record.url?scp=105005774189&partnerID=8YFLogxK
U2 - 10.1111/resp.70047
DO - 10.1111/resp.70047
M3 - Article
C2 - 40407301
AN - SCOPUS:105005774189
SN - 1323-7799
VL - 30
SP - 466
EP - 479
JO - Respirology
JF - Respirology
IS - 6
ER -