Most European severe asthma patients on biologics still had active disease
A registry snapshot of 13,455 adults measures how far the biologic era has moved severe asthma toward remission, and finds the inflammation these drugs target still detectable in most patients.
"Remission" has become the organising ambition of severe asthma care over the past five years, imported from rheumatology and oncology, and defined roughly as no exacerbations, good symptom control, stable lung function and no need for maintenance oral steroids. A cross-sectional analysis of the European severe asthma registry, published in The Lancet Respiratory Medicine, asks how many patients in real European clinics are actually there [s1].
The answer is: not many, and the gap is not mainly an access problem.
The cohort
The study used data from 13,455 adults with severe asthma enrolled in the European Severe Heterogeneous Asthma Registry, Patient-centred Clinical Research Collaboration — SHARP [s1]. Patients had been enrolled in national registries according to local principles and guidelines and in line with European Respiratory Society and American Thoracic Society guidance [s1]. Three per cent, 430 of 13,885, were excluded for lack of consent to the international study or missing medication data [s1].
The population is recognisably the severe asthma population clinicians describe: 59% female — 7,999 of 13,453 — and 82% with adult-onset disease, 8,751 of 10,711 [s1]. Median disease duration was 23 years, with a 95% confidence interval of 20 to 26 years [s1].
How much disease was still active
The analysis assessed four remission-related domains: exacerbations, asthma control, airflow limitation, and maintenance oral corticosteroid use [s1].
Lung function was substantially impaired across the cohort. Fifty-nine per cent of those with spirometry — 4,148 of 7,006 — had an FEV1/FVC ratio of 0.7 or less, and 62%, or 4,680 of 7,568, had an FEV1 below 80% of predicted [s1].
Among patients with data on all domains, 89% — 3,519 of 3,968 — had at least one active disease domain [s1].
And this is despite treatment. Seventy-nine per cent of the cohort, 10,632 of 13,453, were receiving biological therapy [s1]. Even so, more than 66% — 2,621 of 3,968 — still had at least two active domains [s1].
That is the study's central finding, and it is a finding about the ceiling of current therapy rather than about its availability. In a health system context where four in five severe asthma patients are already on a biologic, two-thirds having two or more active disease domains says something about what those drugs can and cannot do.
The biomarkers did not switch off
The mechanistic counterpart is equally striking. Type 2 inflammation — the pathway that eosinophil-, IgE- and interleukin-targeting biologics are designed to interrupt — remained detectable in most patients. Among those with biomarker data, 89%, or 2,806 of 3,153, had at least one elevated type 2 biomarker, measured as blood eosinophils, fractional exhaled nitric oxide or total IgE [s1]. That persisted despite widespread biological and maintenance oral corticosteroid treatment [s1].
The authors' interpretation is that this highlights the enduring nature of type 2 inflammation and the potential inadequacy of current remission strategies with the therapeutic approaches available [s1].
Some caution belongs here. Fractional exhaled nitric oxide and blood eosinophil counts behave differently under different biologics — some agents suppress one marker while leaving another untouched, by design — so "at least one elevated biomarker" on treatment is not straightforwardly evidence of uncontrolled inflammation. The finding is real; its mechanistic reading is less settled than the phrasing suggests.
The fast-progressing subgroup
A separate signal concerns patients not yet on biologics. Among biologic-naive patients with the relevant data, 35% — 1,069 of 3,018 — showed a rapid accumulation of disease burden within less than 10 years, which the authors describe as suggesting a potentially accelerated progression trajectory [s1].
If that holds up, it argues for identifying high-risk patients early rather than escalating after years of decline, which is the study's main clinical recommendation [s1]. It is also, on this design, an inference from a single cross-sectional snapshot: the study observes patients at one point in time and infers trajectory from disease duration, rather than following individuals forward.
What the design can and cannot support
This is a cross-sectional observational analysis of a registry, not a trial and not a longitudinal cohort [s1]. It cannot establish that biologics failed to help any given patient — the counterfactual is unavailable, and patients on biologics are by definition those whose disease was severe enough to warrant them. Confounding by indication runs through everything here.
Missing data is visible in the denominators and worth noticing: the four-domain analysis rests on 3,968 patients of 13,455, and the biomarker analysis on 3,153 [s1]. Those subgroups are not guaranteed to represent the whole cohort, and completeness of registry data tends to be better in specialist centres with research infrastructure.
Funding came from the SHARP Clinical Research Collaboration and consortium partners, including the European Respiratory Society and five pharmaceutical companies: GlaxoSmithKline Research and Development, Chiesi Farmaceutici, Novartis Pharma, Sanofi-Genzyme and Teva Branded Pharmaceutical Products R&D [s1]. Several of those companies market severe asthma biologics. The finding — that their drug class leaves most patients short of remission — cuts against commercial interest, which is a point in the analysis's favour rather than against it, but the funding belongs on the record.
What to watch
The authors call for early identification of high-risk patients and note significant clinical heterogeneity within what is currently treated as one disease [s1]. The practical question for European respiratory services is whether remission is the right target at all for a population with a median disease duration of 23 years and established airflow limitation [s1] — or whether it is achievable mainly in patients treated far earlier than current pathways allow.
Sources
- [s1] Severe asthma and remission prospects in Europe (SHARP): insights from a multicentre observational study based on the European Severe Asthma Registry — The Lancet Respiratory Medicine, published online 24 June 2026. https://doi.org/10.1016/S2213-2600(26)00141-4
Sources
- Severe asthma and remission prospects in Europe (SHARP): insights from a multicentre observational study based on the European Severe Asthma Registry — The Lancet Respiratory Medicine , June 24, 2026
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