Early response toward clinical remission with dupilumab in severe asthma: Real-world cohort

Background Clinical remission is an important treatment goal in severe asthma; however, durable remission frameworks generally require sustained disease control over longer periods. Whether dupilumab induces an early response toward this goal in real-world practice remains unclear.Objective We sought to evaluate early response toward clinical remission at 24 weeks after dupilumab initiation and to identify baseline factors associated with this outcome.Methods In this multicenter, prospective cohort at 13 Japanese institutions, adults with severe asthma treated with dupilumab were followed for 24 weeks. Given the limited observation period, an early response toward clinical remission was defined as meeting modified 4-component remission-oriented criteria: Asthma Control Test score 20 or higher, FEV1 % predicted 80% or higher at week 24, no exacerbations, and no oral corticosteroid use (weeks 16-24). Multivariable logistic regression identified baseline factors associated with this outcome, and receiver-operating characteristic analysis evaluated baseline fractional exhaled nitric oxide (Feno).Results Of 103 enrolled patients, 70 had complete data; 38 (54.3%; 95% CI, 41.9%-66.3%) met the modified remission-oriented criteria at week 24. Higher baseline Feno, higher FEV1 % predicted, and absence of maintenance oral corticosteroid use were associated with this outcome. Baseline Feno showed modest discrimination (area under the curve, 0.65; 95% CI, 0.51-0.78).Conclusions Approximately half of the patients met the modified remission-oriented criteria at 24 weeks after dupilumab initiation, representing an early response toward clinical remission rather than sustained clinical remission itself. Baseline Feno and lung function may help identify patients more likely to show this response.