Clinical remission attainment, definitions, and correlates among patients with severe asthma treated with biologics: a systematic review and meta-analysis.

We aimed to perform a systematic reviewand meta-analysisof clinical remission attainment, definitions, and correlates among patients with severe asthma who have been treated with biologics.

我们的目标是针对接受生物制剂治疗的重症哮喘患者，进行临床缓解达成率、定义和相关因素的系统评价和荟萃分析。

Methods

In this systematic reviewand meta-analysis, we searched Web of Science, Embase, and MEDLINE, using the keywords "asthma" and "remission", for studies published between database inception and June 13, 2024, that reported clinical remission among patients with severe asthma treated with biologics.

在这项系统评价和荟萃分析中，我们使用关键词“哮喘”和“缓解”，在Web of Science、Embase和MEDLINE数据库中检索了自数据库创建以来至2024年6月13日发表的研究，这些研究报道了接受生物制剂治疗的严重哮喘患者的临床缓解情况。

Studies were eligible for inclusion in both the systematic reviewand meta-analysisif they were published in English language peer-reviewed journals and reported rates of clinical remission for patients treated with biologics for severe asthma.

如果研究发表在英语同行评审期刊上，并报告了接受生物制剂治疗的严重哮喘患者的临床缓解率，那么这些研究就有资格纳入系统评价和荟萃分析。

There were no limitations by study design.

研究设计没有限制。

Two reviewers independently screened identified papers (AS and CR), with disagreements resolved through consensus or referral to a third reviewer (JB).

两位评审员独立筛选已识别的论文（AS和CR），对于分歧通过共识解决或转交给第三位评审员（JB）。

Study-level data on study characteristics, clinical remission definitions, clinical remission attainment, and the potential correlates of clinical remission were extracted independently by two reviewers (AS and CR) using Covidence.

两位评审员（AS和CR）使用Covidence独立提取了关于研究特征、临床缓解定义、临床缓解达成以及临床缓解潜在相关因素的研究级数据。

We defined a three-component definition of clinical remission, which included use of maintenance oral corticosteroids, exacerbations, and asthma symptom burden, and a four-component definition, which additionally included lung function.

我们定义了临床缓解的三重组成部分，包括使用维持口服皮质类固醇、发作次数和哮喘症状负担，以及四重组成部分，后者额外包括肺功能。

We meta-analysed the rate of attainment of clinical remission and assessed the correlates of clinical remission using DerSimonian-Laird random-effects models.

我们通过使用DerSimonian-Laird随机效应模型对临床缓解达成率进行了荟萃分析，并评估了临床缓解的相关因素。

Statistical heterogeneity was assessed using the I2 statistic.

使用I2统计量评估了统计异质性。

This study was registered with PROSPERO, CRD42024507233.

本研究已在PROSPERO注册，注册号为CRD42024507233。

Results

Our search identified 3014 potentially eligible studies, of which 1812 were screened. 25 studies were included, which reported 28 analyses of clinical remission attainment. 68 definitions of clinical remission were identified, of which 48 were unique.

我们的搜索共识别出3014项可能符合条件的研究，其中1812项进行了筛选。共有25项研究被纳入，这些研究报告了28项临床缓解达成情况的分析。共识别出68种临床缓解的定义，其中48种是独特的。

Little consensus was found between studies in terms of the clinical remission definition, particularly for symptoms and lung function.

研究之间在临床缓解定义方面几乎没有共识，特别是在症状和肺功能方面。

Eight analyses used the three-component definition of clinical remission and 25 used the four-component definition.

八项分析使用了临床缓解的三成分定义，25项使用了四成分定义。

The pooled proportion of patients who attained clinical remission was 38% (95% CI 29-47; I2=93%) for the three-component definition and 30% (27-34; I2=83%) for the four-component definition.

综合三项定义，达到临床缓解的患者比例为38%（95%置信区间29-47；I2=93%），而四项定义下为30%（27-34；I2=83%）

Several pulmonary factors were associated with lower clinical remission rates, including worse FEV1 (odds ratio 0·09 [95% CI 0·01-0·92]; I2=87%), worse asthma symptoms (0·23 [0·17-0·33]; I2=0%), longer asthma duration (0·49 [0·32-0·76]; I2=22%), and use of maintenance oral corticosteroids (0·57 [0·40-0·79]; I2=49%).

几项肺部因素与较低的临床缓解率相关，包括较差的FEV1（比值比0·09 [95%置信区间0·01-0·92]；I2=87%）、更严重的哮喘症状（0·23 [0·17-0·33]；I2=0%）、更长的哮喘病程（0·49 [0·32-0·76]；I2=22%）以及使用维持性口服皮质类固醇（0·57 [0·40-0·79]；I2=49%）

The presence of comorbidities, in particular depression (0·38 [0·23-0·61]; I2=6%) and obesity (0·41 [0·31-0·54]; I2=0%), were important non-pulmonary barriers to clinical remission.

合并症的存在，特别是抑郁症（0.38 [0.23-0.61]；I2=6%）和肥胖症（0.41 [0.31-0.54]；I2=0%），是临床缓解的重要非肺部障碍。

interpretation

Clinical remission is an achievable goal for a minority of patients with severe asthma treated with biologics.

对于接受生物制剂治疗的严重哮喘患者，临床缓解是一个少数患者可以实现的目标。

Definitions of clinical remission varied substantially between studies, and materially affected attainment, suggesting an urgent need for further consensus-driven definitions.

各研究对临床缓解的定义差异显著，这显著影响了缓解的达成，迫切需要进一步达成基于共识的定义。

Longer disease duration, higher asthma severity, and the presence of comorbidities were identified as important barriers to clinical remission, suggesting that earlier intervention with effective treatments and a broader treatable traits approach might improve outcomes.

研究发现，疾病持续时间更长、哮喘严重程度更高以及合并症的存在是临床缓解的重要障碍，这表明早期干预并采用有效的治疗方法以及更广泛的可治疗特性方法可能会改善结果。

funding

Health Data Research UK, Inflammation and Immunity driver project.

英国健康数据研究，炎症与免疫驱动项目。