Asthma Remission Goals and Where Biologic Adherence Breaks Down

In "Asthma Remission Goals and Where Biologic Adherence Breaks Down," our experts turn to the gap between today's outcomes and clinical remission, and to the practical points at which adherence breaks down.

Dr. Wechsler reviews the unmet needs that remain beyond authorization reform. With 7 biologics now available, clinicians have reduced exacerbations, tapered patients off steroids, improved lung function, and eased symptoms. Yet exacerbations fall by about 50%, and he emphasizes that it is only 50%.

Lung function improves in most patients but normalizes in relatively few. Symptoms improve, but patients are rarely symptom-free. This leads him to the concept of remission: a sustained period with no exacerbations, no corticosteroid use, normalized lung function, and no significant symptoms. He calls remission the holy grail. It is achievable in roughly 20% to 40% of patients when the right therapy reaches the right patient.

Dr. Bernstein observes that sustained disease modification has not yet been reached. Dr. Wechsler agrees. It is a good time to have bad asthma, he says, but asthma is not cured.

Dr. Mosnaim, whose research focuses on adherence and persistence, concentrates on biologics. Some patients never start therapy because prior authorization delays cause the prescription to get lost. Others abandon it after learning their out-of-pocket cost.

For patients who do start, she sets expectations early. Full benefit may take 4 to 6 months. Her target is at least a 50% reduction in exacerbations and oral steroid use by 6 months. She explains that these drugs primarily prevent exacerbations rather than control day-to-day symptoms.

At follow-up, she checks fractional exhaled nitric oxide, spirometry, and the Asthma Control Test, and reviews exacerbations and steroid use. Patients who still feel breathless need reminding that avoiding exacerbations protects long-term health. She notes that patients should continue inhaled steroids, and high inhaled steroid users tend to adhere best to biologics. Adherence often drops at 6 months. Some patients stop once they feel well or worry about cost, then exacerbate and restart.

Up next, in "Setting Realistic Asthma Treatment Goals Across Diverse Patient Populations," Dr. Chupp asks whether clinicians are raising the bar toward remission, and Dr. Mosnaim explains why her first priority remains stopping exacerbations.