B32-50 Base4score Predicts 12-Month Strict Clinical Remission in Tezepelumab-Treated Severe Asthma: A Real-World Registry Study
J Garcia Rivero, A Hannaoui Anaaoui, A Pallares Sanmartin, M Blanco Aparicio, R García Hernáez, M Garcia-Gallardo Sanz, U Calvo-Álvarez, L Carazo-Fernández, T Hermida Valverde, S Dorronsoro, I Carrascosa-Anguiano, I Lobato Astiárraga, I de los Santos, L Pérez de Llano, P Álvarez Vega, B Abascal-Bolado, M SantibañezAbstract
Rationale
Clinical remission is an emerging treat-to-target endpoint in severe asthma, yet remission rates are typically reported without accounting for baseline disease burden. We aimed to develop an empirically weighted baseline composite score (Base4Score) to stratify the probability of achieving strict 12-month clinical remission in severe asthma treated with tezepelumab.
Methods
We performed a multicentre realworld analysis of prospectively collected registry data from adults with severe asthma initiating tezepelumab (2022-2024). Base4Score integrates four baseline domains aligned with remission frameworks: poor symptom control (Asthma Control Test <20), ≥1 severe exacerbation in the prior 12 months, maintenance oral corticosteroid (OCS) use, and forced expiratory volume in 1 second (FEV1) <80% predicted. Domain weights were derived using the inverse probability of “correcting” each abnormality at 12 months and summed into a continuous score. Strict clinical remission at 12 months required: Asthma Control Test ≥20, no severe exacerbations, no maintenance OCS, and FEV1 ≥80% predicted. Logistic regression evaluated the association between Base4Score and nonremission, adjusted for age, sex, smoking status, T2 phenotype, and prior biologic exposure.
Results
Ninetythree patients initiated tezepelumab; 83 had complete baseline data and 77 had complete 12month remission data. Strict clinical remission occurred in 16/77 (20.8%). Remission rates declined across score strata: 38.1% for scores ≤4, 16.7% for >4-<9, and 11.9% for ≥9 (ptrend=0.018). Each 1point increase in Base4Score increased the adjusted odds of nonremission (OR 1.24; 95% CI 1.01-1.52). Patients with scores ≥9 had a sevenfold higher adjusted risk of nonremission versus ≤4 (OR 7.15; 95% CI 1.44-35.48). An unweighted 0-4 score (one point per abnormal domain) was not statistically significant.
Conclusions
Base4Score is a pragmatic, clinically grounded baseline severity index that predicts strict 12month remission in tezepelumabtreated severe asthma and may support individualized remission expectations and treattotarget decisions. External validation across biologics and settings is warranted.
This abstract is funded by: None