Is it feasible to assess clinical remission in asthma via a customized data extraction approach from a real-world clinical electronic medical records database in Japan? A retrospective real-world study

Abstract

Clinical remission (CR) is an ambitious and attainable treatment goal for patients with asthma. This retrospective, observational study determined the feasibility of assessing CR using an electronic medical record (EMR) database. Data from the JAMDAS database were analyzed for patients with asthma initiating fluticasone furoate/umeclidinium/vilanterol single-inhaler triple therapy between August 18, 2020 and December 31, 2024. Asthma Control Test (ACT) scores were extracted using structured query language. For exacerbations, hospitalization and emergency transport data were extracted using a large language model. The proportion of patients meeting Japanese Practical Guidelines for Asthma Management 2024 CR definition (oral corticosteroid [OCS]-free, no exacerbations, ACT ≥ 23), treatment patterns, adherence and persistence were assessed at 3-month intervals until 18-months post-initiation. Additionally, forced expiratory volume in 1 s (FEV1%)/forced vital capacity and fractional exhaled nitric oxide (FeNO) test frequency were extracted. Of 32 258 eligible patients, only 1.8–3.0%, 0.5–1.5% and 4.5–10.1% had 3- to 18-month ACT, FEV1% or FeNO data available. Among patients with 3-month ACT data (2.9% [n = 934/32 258]), 98.6% (n = 921/934) had no exacerbations and 81.0% (n = 757/934) had no OCS use. Among evaluable patients (3-months: 2.9%; 18-months: 3.0%), 41.1% (n = 384/934) met all CR components at 3-months and 69.3% (n = 199/287) at 18-months post-initiation. This study suggests it may be feasible to assess CR using EMR data in Japanese patients with asthma. However, infrequent recording of CR components in clinical practice, particularly ACT and lung function tests, limits availability of EMR data for CR assessments and the potential generalizability of CR findings.