For the roughly one-third of severe asthma patients on biologics who eventually stop treatment — whether by choice, financial necessity, or apparent remission — the clinical stakes of that decision are poorly mapped. A clearer picture of who fares well versus who relapses could meaningfully reshape how clinicians time discontinuation and counsel patients on long-term expectations.
This retrospective cohort from real-world practice analyzed 118 adults with severe asthma who had received biologic therapy for at least 12 months before stopping for a minimum of three consecutive months. Kaplan-Meier modeling estimated that 65% remained exacerbation-free at the 12-month mark post-cessation — a notably optimistic figure, though it implies more than one in three experienced a relapse within a year. Multivariable Cox regression identified baseline blood eosinophilia at or above 300 cells/µL, persistent sputum symptoms during biologic treatment, and discontinuation driven by inadequate response or financial pressure as independent predictors of post-cessation exacerbation. Conversely, robust clinical response and absence of exacerbations immediately before stopping were associated with favorable outcomes. In biologic class-stratified models, residual sputum symptoms held as a significant predictor specifically after discontinuing anti-IL-5 therapies.
This study adds real-world texture to a thin evidence base. Most biologic trials in severe asthma are designed to demonstrate efficacy during treatment, not durability after cessation. The finding that eosinophilia at baseline — rather than during treatment — predicts relapse is particularly instructive: it suggests underlying type-2 inflammatory drive may not be fully suppressed even when symptoms improve. The retrospective single-center design limits causal inference, and the 118-patient sample constrains subgroup power. Nonetheless, the identification of sputum persistence as a class-specific signal for anti-IL-5 stoppers is a clinically actionable nuance. Overall, this is confirmatory and hypothesis-generating rather than paradigm-shifting — but it offers practical stratification criteria that prospective trials should now formally test.