Super-Responders to Biologic Treatment in Type 2–High Severe Asthma: Passing Fad or a Meaningful Phenotype?

Defining super-response to biologic treatment is a major concern in severe asthma. Although many definitions have been proposed, there is still a gap between the clinical perception of the super-response and a standardized classification. The current definition of super-response mainly relies on several clinical features, while many aspects of severe asthma inflammation and lung function are still poorly considered. Furthermore, many criteria of severe asthma super-response overlap with those of the clinical remission, leaving room for possible misclassifications. In this context, identifying the correct trajectory linking these 2 aspects of type 2–high severe asthma could help clinicians to understand which factors can predict a greater response to biologic therapies. In this paper, we review various aspects of super-response assessment, proposing some new criteria for its definition as well as new perspectives on its relationship with severe asthma clinical remission. Defining super-response to biologic treatment is a major concern in severe asthma. Although many definitions have been proposed, there is still a gap between the clinical perception of the super-response and a standardized classification. The current definition of super-response mainly relies on several clinical features, while many aspects of severe asthma inflammation and lung function are still poorly considered. Furthermore, many criteria of severe asthma super-response overlap with those of the clinical remission, leaving room for possible misclassifications. In this context, identifying the correct trajectory linking these 2 aspects of type 2–high severe asthma could help clinicians to understand which factors can predict a greater response to biologic therapies. In this paper, we review various aspects of super-response assessment, proposing some new criteria for its definition as well as new perspectives on its relationship with severe asthma clinical remission. Have we reached our final destination with biologics in severe uncontrolled asthma?The Journal of Allergy and Clinical Immunology: In PracticeVol. 11Issue 5PreviewPortacci et al1 eloquently proposed a comprehensive assessment model for defining super-responders to biologics in patients with type 2 (T2)-high severe uncontrolled asthma (SUA). This in turn begs the pertinent question as to whether it is preferable to block upstream epithelial alarmins such as thymic stromal lymphopoietin (TSLP) or downstream cytokines such as IL4, IL5, and IL13 (Figure 1) in order to achieve the best response in a given patient.2 Full-Text PDF