Early Reduction of FeNO on Anti-IL5 Biologics Is Associated With Clinical Remission of Severe Asthma

Marianne Baastrup Soendergaard; Susanne Hansen; Kjell Erik Julius Håkansson; Anna von Bülow; Anne-Sofie Bjerrum; Johannes Martin Schmid; Sofie Lock Johansson; Linda Makowska Rasmussen; Claus Rikard Johnsen; Barbara Bonnesen Bertelsen; Niels Steen Krogh; Ole Hilberg; Charlotte Suppli Ulrik; Celeste Porsbjerg

doi:10.1111/all.16425

Early Reduction of FeNO on Anti-IL5 Biologics Is Associated With Clinical Remission of Severe Asthma

Bidragets oversatte titel: Tidlig reduktion i FeNO ved anti IL-5 behandling er associeret med klinisk remission

Marianne Baastrup Soendergaard^*
, Susanne Hansen
, Kjell Erik Julius Håkansson
, Anna von Bülow
, Anne-Sofie Bjerrum
, Johannes Martin Schmid
, Sofie Lock Johansson
, Linda Makowska Rasmussen
, Claus Rikard Johnsen
, Barbara Bonnesen Bertelsen
, Niels Steen Krogh
, Ole Hilberg
, Charlotte Suppli Ulrik
, Celeste Porsbjerg

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin - Lungesygdomme

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

4 Citationer (Scopus)

Abstract

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.

Bidragets oversatte titel	Tidlig reduktion i FeNO ved anti IL-5 behandling er associeret med klinisk remission
Originalsprog	Engelsk
Tidsskrift	Allergy
Vol/bind	80
Nummer	4
Sider (fra-til)	986-995
Antal sider	10
ISSN	0105-4538
DOI	https://doi.org/10.1111/all.16425
Status	Udgivet - apr. 2025

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Soendergaard, M. B., Hansen, S., Håkansson, K. E. J., von Bülow, A., Bjerrum, A.-S., Schmid, J. M., Johansson, S. L., Rasmussen, L. M., Johnsen, C. R., Bertelsen, B. B., Krogh, N. S., Hilberg, O., Ulrik, C. S., & Porsbjerg, C. (2025). Early Reduction of FeNO on Anti-IL5 Biologics Is Associated With Clinical Remission of Severe Asthma. Allergy, 80(4), 986-995. https://doi.org/10.1111/all.16425

@article{27e4b96c466b42a39e5f80c1eca86a07,

title = "Early Reduction of FeNO on Anti-IL5 Biologics Is Associated With Clinical Remission of Severe Asthma",

abstract = "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.",

keywords = "asthma, biologics, biomarkers",

author = "Soendergaard, \{Marianne Baastrup\} and Susanne Hansen and H{\aa}kansson, \{Kjell Erik Julius\} and \{von B{\"u}low\}, Anna and Anne-Sofie Bjerrum and Schmid, \{Johannes Martin\} and Johansson, \{Sofie Lock\} and Rasmussen, \{Linda Makowska\} and Johnsen, \{Claus Rikard\} and Bertelsen, \{Barbara Bonnesen\} and Krogh, \{Niels Steen\} and Ole Hilberg and Ulrik, \{Charlotte Suppli\} and Celeste Porsbjerg",

year = "2025",

month = apr,

doi = "10.1111/all.16425",

language = "English",

volume = "80",

pages = "986--995",

journal = "Allergy",

issn = "0105-4538",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "4",

}

Soendergaard, MB, Hansen, S, Håkansson, KEJ, von Bülow, A, Bjerrum, A-S , Schmid, JM, Johansson, SL, Rasmussen, LM, Johnsen, CR, Bertelsen, BB, Krogh, NS, Hilberg, O, Ulrik, CS & Porsbjerg, C 2025, 'Early Reduction of FeNO on Anti-IL5 Biologics Is Associated With Clinical Remission of Severe Asthma', Allergy, bind 80, nr. 4, s. 986-995. https://doi.org/10.1111/all.16425

Early Reduction of FeNO on Anti-IL5 Biologics Is Associated With Clinical Remission of Severe Asthma. / Soendergaard, Marianne Baastrup; Hansen, Susanne; Håkansson, Kjell Erik Julius et al.
I: Allergy, Bind 80, Nr. 4, 04.2025, s. 986-995.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

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

PY - 2025/4

Y1 - 2025/4

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 - https://www.scopus.com/pages/publications/85211921236

U2 - 10.1111/all.16425

DO - 10.1111/all.16425

M3 - Journal article

C2 - 39673455

SN - 0105-4538

VL - 80

SP - 986

EP - 995

JO - Allergy

JF - Allergy

IS - 4

ER -

Early Reduction of FeNO on Anti-IL5 Biologics Is Associated With Clinical Remission of Severe Asthma

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