Trial reportThe European respiratory journal2024
Titration of anti-IL-5 biologics in severe asthma: an open-label randomised controlled trial (the OPTIMAL study).
Trial report in The European respiratory journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Asthma and Sinonasal Diseases: Shared Clinical Comorbidities, Inflammatory Pathways and Management Strategies.Medical sciences (Basel, Switzerland) · 2026Review
- Navigating the small airways with tezepelumab.ERJ open research · 2026Article
- ERS Congress 2025: highlights from the Airway Diseases Assembly.ERJ open research · 2026Article
- Feasibility of a 50% Dosing Interval Extension of Anti-IL-5 Biologics in Patients with Severe Asthma in Clinical Remission: A Real-World Validation Study.Journal of asthma and allergy · 2026Article
- Predictive Factors And Treatments Associated with Clinical Remission in Severe Eosinophilic Asthma.Journal of inflammation research · 2026Review
- Case Report: From misdiagnosis to successful treatment using mepolizumab in ANCA-negative severe EGPA-clinical lessons in eosinophil-targeted therapy.Frontiers in medicine · 2026Article
- Biologic Therapies for Severe Asthma: Current Insights and Future Directions.Journal of clinical medicine · 2025Review
- Recent evidence for stepping down severe asthma therapies.Current opinion in pulmonary medicine · 2025Review
- Biologic Agents in Idiopathic Hypereosinophilic Syndrome.Pharmaceuticals (Basel, Switzerland) · 2025Article
- Pro: Clinical remission in asthma - implications for asthma management.European respiratory review : an official journal of the European Respiratory Society · 2025Review
- Biologics in severe asthma: a state-of-the-art review.European respiratory review : an official journal of the European Respiratory Society · 2025Review
- Case Report: Extending dosing intervals of biologics in adults severe asthma: a case series.Frontiers in allergy · 2025Article
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAnti-interleukin (IL)-5 biologics effectively reduce exacerbations and the need for maintenance oral corticosteroids (mOCS) in severe eosinophilic asthma. However, it is unknown how long anti-IL-5 treatment should be continued. Data from clinical trials indicate a gradual but variable loss of control after treatment cessation. In this pilot study of titration, we evaluated a dose-titration algorithm in patients who had achieved clinical control on an anti-IL-5 biologic.
methodsIn this open-label randomised controlled trial conducted over 52 weeks, patients with clinical control (no exacerbations or mOCS) on anti-IL-5 treatment were randomised to continue with unchanged intervals or have dosing intervals adjusted according to a titration algorithm that gradually extended dosing intervals and reduced them again at signs of loss of disease control. The OPTIMAL algorithm was designed to down-titrate dosing until signs of loss of control, to enable assessment of the longest dosing interval possible.
resultsAmong 73 patients enrolled, 37 patients were randomised to the OPTIMAL titration arm; 78% of patients tolerated down-titration of treatment. Compared to the control arm, the OPTIMAL arm tended to have more exacerbations during the study (32%
conclusionThis study serves as a proof of concept for titration of anti-IL-5 biologics in patients with severe asthma with clinical control on treatment, and the OPTIMAL algorithm provides a potential framework for individualising dosing intervals in the future.
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