Uncontrolled, severe asthma remains a significant clinical challenge, affecting a small proportion of asthma patients worldwide. Despite advancements in treatment options, a subset of patients continues to experience frequent exacerbations, uncontrolled symptoms, and impaired quality of life. The advent of biological therapies has revolutionized the management of severe asthma, offering targeted treatments that address specific inflammatory pathways. This review provides a comprehensive overview of the efficacy and response criteria of biological treatments in severe asthma, focusing on clinical, functional, and inflammatory markers used to help in the evaluation of the biologic treatment. Key response criteria include symptom control, reduction in exacerbations, improvement in lung function, and a reduction in or the discontinuation of oral corticosteroids. Biomarkers such as blood eosinophils and exhaled nitric oxide (FeNO) are essential tools in guiding treatment adjustments. Real-world studies underscore the importance of personalized treatment strategies, as variability in response to biological therapies can be significant. The emergence of tools such as the FEOS score and EXACTO questionnaire offer quantitative measures for assessing biological response and guiding clinical decisions. Additionally, predictive factors for better or poorer responses, such as pre-treatment lung function and comorbidities, like obesity and rhinosinusitis, are critical in patient selection. This review highlights the need for ongoing reassessments and potential modifications of therapy in cases of suboptimal response. Practical considerations for switching biological therapies are discussed, emphasizing the importance of tailoring treatments to individual patient profiles and disease phenotypes. With the continued development of personalized medicine, the outlook for patients with severe asthma is improving, selecting specific biomarkers to improve the selection of the biologic treatment.

Daniel Laorden laordendaniel1@gmail.com 1 Irene Hern?ndez 23 Javier Dom?nguez-Ortega 2 David Romero 1 Rodolfo ?lvarez-Sala 1 Santiago Quirce 2...

Response to biologics in severe uncontrolled asthma (SUA) can be classified as super-responders, good responders, non-responders, and those achieving clinical remission. This study evaluates the long-term response to mepolizumab in patients with severe eosinophilic asthma and assesses the rate of asthma clinical remission over four years in a real-life setting. A single-center, observational, retrospective study was conducted at La Paz University Hospital (Madrid, Spain) from 2017 to 2022. Patients with SUA treated with mepolizumab 100mg every four weeks for at least three years were included. Response to mepolizumab was classified into good responders, super-responders, non-responders, and patients achieving clinical remission after three and four years of treatment. 27 patients (67% women; mean age 37.7 years) were included. 58% of patients achieved remission after three years of treatment, increasing to 63% after four years. Similar trends were observed in super-responders and good responders. We found that a significant number of patients treated with mepolizumab in a real-life setting can achieve asthma remission, particularly when compared to other similar studies. By distinguishing these different degrees of response, clinicians can better understand the patient's condition and make more informed decisions about whether to continue with the current biologic therapy or consider switching to a different treatment.