TY - JOUR
T1 - Early Reduction of FeNO on Anti-IL5 Biologics Is Associated With Clinical Remission of Severe Asthma
AU - Soendergaard, Marianne Baastrup
AU - Hansen, Susanne
AU - Håkansson, Kjell Erik Julius
AU - von Bülow, Anna
AU - Bjerrum, Anne-Sofie
AU - Schmid, Johannes Martin
AU - Johansson, Sofie Lock
AU - Rasmussen, Linda Makowska
AU - Johnsen, Claus Rikard
AU - Bertelsen, Barbara Bonnesen
AU - Krogh, Niels Steen
AU - Hilberg, Ole
AU - Ulrik, Charlotte Suppli
AU - Porsbjerg, Celeste
N1 - © 2024 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
PY - 2024/12/14
Y1 - 2024/12/14
N2 - BACKGROUND: In patients with severe asthma, treatment with anti-interleukin-5 (IL-5) biologics can lead to a reduction in fractional exhaled nitric oxide (FeNO) in some patients. The clinical implications of varying FeNO responses to anti-IL-5 biologics remain unclear. This study aims to categorise patients based on their FeNO response to anti-IL-5 biologics and evaluate the association of these categories with clinical outcomes.METHODS: We used the Danish Severe Asthma Register (DSAR) to identify the early FeNO response profiles in patients receiving anti-IL5 biologics. We defined FeNO responders as patients with elevated FeNO levels at baseline and a decrease corresponding to the minimal clinically important difference (MCID) at 4 months of follow-up and FeNO non-responders as those who did not experience a decrease.RESULTS: We identified 403 patients on anti-IL5 treatment in DSAR, and 265 (66%) had elevated FeNO levels at baseline. After 4 months of treatment, 151 (57%) patients showed a significant decrease in FeNO levels, and 114 (43%) did not. FeNO responders were more likely to achieve clinical remission of asthma (34% vs. 19%, p = 0.01, OR 2.11, CI 1.04, 5.18, p = 0.03) than FeNO non-responders after 12 months of treatment. The higher remission rates in FeNO responders mainly reflected a higher rate of normalisation of lung function.CONCLUSIONS: FeNO levels were reduced after anti-IL5 treatment in a significant proportion of patients treated with anti-IL5, and this was associated with clinical remission. Early FeNO response to anti-IL5 could potentially be used as a biomarker to guide management decisions with biologics towards remission of disease in severe asthma.
AB - BACKGROUND: In patients with severe asthma, treatment with anti-interleukin-5 (IL-5) biologics can lead to a reduction in fractional exhaled nitric oxide (FeNO) in some patients. The clinical implications of varying FeNO responses to anti-IL-5 biologics remain unclear. This study aims to categorise patients based on their FeNO response to anti-IL-5 biologics and evaluate the association of these categories with clinical outcomes.METHODS: We used the Danish Severe Asthma Register (DSAR) to identify the early FeNO response profiles in patients receiving anti-IL5 biologics. We defined FeNO responders as patients with elevated FeNO levels at baseline and a decrease corresponding to the minimal clinically important difference (MCID) at 4 months of follow-up and FeNO non-responders as those who did not experience a decrease.RESULTS: We identified 403 patients on anti-IL5 treatment in DSAR, and 265 (66%) had elevated FeNO levels at baseline. After 4 months of treatment, 151 (57%) patients showed a significant decrease in FeNO levels, and 114 (43%) did not. FeNO responders were more likely to achieve clinical remission of asthma (34% vs. 19%, p = 0.01, OR 2.11, CI 1.04, 5.18, p = 0.03) than FeNO non-responders after 12 months of treatment. The higher remission rates in FeNO responders mainly reflected a higher rate of normalisation of lung function.CONCLUSIONS: FeNO levels were reduced after anti-IL5 treatment in a significant proportion of patients treated with anti-IL5, and this was associated with clinical remission. Early FeNO response to anti-IL5 could potentially be used as a biomarker to guide management decisions with biologics towards remission of disease in severe asthma.
KW - asthma
KW - biologics
KW - biomarkers
UR - http://www.scopus.com/inward/record.url?scp=85211921236&partnerID=8YFLogxK
U2 - 10.1111/all.16425
DO - 10.1111/all.16425
M3 - Journal article
C2 - 39673455
SN - 0105-4538
JO - Allergy
JF - Allergy
ER -