Biomarkers might predict asthma remission after anti-IL-5 therapy
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Key takeaways:
- Four sputum type 2 markers may predict 1-year remission in patients with severe asthma following anti-IL-5 therapy.
- Male sex was an additional possible predictor of remission.
Sputum neutrophil percentage and levels of eotaxin-1, IL-5 and eosinophil peroxidase may be used to predict remission among patients with severe asthma 1 year after anti-IL-5 therapy, according to a study published in CHEST.
“Sputum type 2 markers levels could be surrogate markers of response 1 year after anti-IL-5 treatment,” Catherine Moermans, PhD, laboratory manager at Liège University Hospital, and colleagues wrote.
In an observational study, Moermans and colleagues assessed 52 patients with severe eosinophilic asthma from a clinic in Liege, Belgium, treated with an anti-IL-5 agent (mepolizumab [Nucala, GSK], n = 51; reslizumab [Cinqair, Teva], n = 1) to find biomarkers that predict remission 1 year after receiving the treatment.
According to the researchers, several components made up the classification for remission, including:
- no chronic treatment with oral corticosteroids;
- no exacerbation;
- an asthma control questionnaire score less than 1.5 and/or an asthma control test score greater than 19;
- FEV1 of 80% predicted or higher and/or improvement of FEV1 of 10% or higher; and
- a blood eosinophil count less than 300 cells/L.
To find differences between those who achieved remission and those who did not, researchers evaluated several clinical and biological factors in patients’ sputum prior to receipt of the therapy: eosinophil peroxidase (EPX), IgE, IL-3, IL-4, IL-5, IL-13, IL-25, IL-33, granulocyte-macrophage colony-stimulating factor, thymic stromal lymphopoietin (TSLP) and eotaxin-1 levels.
At the 1-year mark, 11 (8 men) patients met the criteria for remission. Compared with those who did not meet remission criteria (n = 41; 15 men), patients in remission had a decreased sputum neutrophil percentage (P = .007) and increased sputum eosinophil (P = .006), macrophage (P = .02) and lymphocyte counts (P = .04) at baseline.
Prior to treatment, patients who achieved remission also had elevated sputum eotaxin-1 (P = .046), TSLP (P = .04), IL-5 (P = .002), EPX (P = .001) and IgE protein (P = .006) levels vs. patients who did not achieve remission. According to researchers, these are all sputum type 2 biomarkers.
The remaining factors measured at baseline did not significantly differ according to remission status.
Researchers found several potential predictors of asthma remission after conducting univariate regression analysis, which included sputum neutrophil percentage (OR = 1.5; 95% CI, 1.08-2.07) and levels of eotaxin-1 (OR = 1.321; 95% CI, 1-1.679), IL-5 (OR = 1.727 per 5 pg/mL; 95% CI, 1.1-2.67) and EPX (OR = 1.264 per 50 ng/mL; 95% CI, 1-1.576).
Additionally, male sex (OR = 4.6; 95% CI, 1.1-20.126) was a potential predictor for 1-year remission when compared with female sex.
A study involving a larger set of patients with asthma is needed to validate these findings, according to researchers.
“Sputum indeed is now recommended by American Thoracic Society and European Respiratory Society guidelines in the management of severe asthma and should be reimbursed by local authorities because it could predict patients who will achieve remission after administration of these very costly biologics,” Moermans and colleagues wrote.
Although results from this study by Moermans and colleagues need to be confirmed in a larger study, the present findings emphasize why biomarkers that predict remission are important in prescribing biologics, according to an accompanying editorial by Simon Couillard, MD, PhD, assistant professor at the Université de Sherbrooke in Quebec, Canada, and Andréanne Côté, MD, FRCPC, physician at the Quebec University Institute of Cardiology and Pulmonology (Lavel Hospital).
“Crucially, prescribing a biologic in asthma is not only about clinical characteristics,” Couillard and Côté wrote. “We must go one level deeper, using surrogate measures (biomarkers) to decipher what and where the underlying problem of a specific patient’s disease is, identifying the most at-risk patients for asthma attacks, airway remodeling, and loss of quality of life; we must strive to maximize treatment benefits by selecting the right biologic for the right patient.”