Search Results (362)

Background and Objectives: Therapeutic goals for ulcerative colitis (UC) have expanded beyond symptom control to include mucosal and histological healing. However, the long-term prognostic value of achieving both targets remains uncertain, particularly in Asian populations. This study aimed to evaluate long-term outcomes and relapse predictors in patients with UC who achieved both endoscopic and histologic remission. Materials and Methods: This prospective observational study consecutively enrolled adults with clinically inactive UC who attained endoscopic remission (Mayo endoscopic subscore = 0) and histologic remission (Nancy index ≤1) between June 2014 and May 2018. Demographic, clinical, and laboratory data—including fecal calprotectin—were collected. Clinical relapse was defined as a Mayo score increase >3 or initiation of systemic corticosteroids or biologics. Patients were followed longitudinally for a median of 55 months (minimum 12 months), and relapse risk was evaluated using Kaplan–Meier and univariate Cox regression analyses. Results: A total of 41 patients were included (mean age 54 ± 14 years; 56% male). The median follow-up was 54 months (range 17–78). Ten patients (24.4%) relapsed during follow-up, with cumulative relapse rates of 9.8%, 10.3%, 15.8%, and 24.1% at 12, 24, 36, and 48 months, respectively. Kaplan–Meier analyses demonstrated significantly higher relapse in patients with non-E1 disease (E2 + E3, p = 0.021), immunomodulator use (p = 0.008), and biologics use (p = 0.007). In univariate Cox regression, immunomodulator (HR 4.7, 95% CI 1.3–16.4, p = 0.02) and biologics use (HR 4.9, 95% CI 1.4–17.5, p = 0.01) were significant predictors of relapse, whereas disease extent showed only a non-significant trend with wide CIs. Baseline fecal calprotectin was higher in the relapse group (182 ± 370 μg/g vs. 108 ± 164 μg/g) but was not statistically significant. Conclusions: Approximately one-quarter of UC patients who achieved dual remission relapsed within 4 years. These findings highlight the limitations of using dual remission as the sole therapeutic endpoint and underscore the need for additional prognostic factors. High-risk subgroups—such as those with extensive disease or prior exposure to advanced therapies—may require closer monitoring and individualized strategies. Future multicenter studies integrating clinical, endoscopic, histologic, and biomarker data are needed to refine relapse prediction. Full article

Background: Methotrexate (MTX) is the most used anti-rheumatic drug for the treatment of early rheumatoid arthritis (ERA) patients, with an adequate response rate of only 30–40%. Thus, early detection of response failure is very crucial to prevent permanent disability. Objectives: We aimed to provide an update on the current evidence of potential predictive biomarkers of MTX treatment response (MTX-TR) in patients with ERA. Materials and methods: PubMed/MEDLINE, Scopus, EBSCO, and Cochrane Library were searched for studies that investigated a multitude of predictive metabolites of MTX-TR in ERA patients during the 2000–2024 period. This study was registered in PROSPERO (ID: CRD42024547651). Results: We determined that 31 out of 102 metabolites studied were the best predictive of MTX-TR in ERA, using clinical response (DAS28-ESR score). Our results on serum protein profiles revealed that higher pre-treatment levels of myeloid-related proteins, MTX–polyglutamates, choline, inosine, hypoxanthine, guanosine, nicotinamide, and diglyceride, and lower pre-treatment levels of N-methyl isoleucine, 2,3-dihydroxy butanoic acid, nor-nicotine, glucosylceramide, and itaconic acid, were associated with a good MTX-TR. However, lower baseline plasma itaconate and its derivatives and haptoglobin, but a higher baseline level of galactosylated glycans (FA2G) of IgG1, were associated with a good response to MTX. The results on immune cell biology indicated that higher pre-treatment of regulatory B cells, lower pre-treatment of Treg, and RDW were correlated with a good MTX-TR. The results on inflammatory biomarkers showed that a lower IL-1ra/IL1B ratio and IL-6 levels after MTX indicated a good response. Conclusions: This study provides an update on the current evidence of the potential predictive metabolites for the best MTX-TR in ERA patients. We revealed that few biomarkers resulted in a remission state of patients with ERA. These biomarkers are promising but not yet ready for routine clinical use; they warrant validation in larger prospective trials. We recommend that, for the implementation of personalized medicine, these biomarkers should be the first-line biomarkers for use in routine clinical practice after validation. Full article

Follicular lymphoma management is rapidly evolving with advanced cellular therapies. This review examines the optimal sequencing of autologous stem cell transplantation (autoSCT), allogeneic stem cell transplantation (alloSCT), and CAR T-cell therapy. AutoSCT is a crucial intervention for chemosensitive relapsed FL, prolonging progression-free survival, though not typically curative. AlloSCT, offering a potential cure via a graft-versus-lymphoma effect, carries significant risks like graft-versus-host disease and non-relapse mortality, thus primarily serving as a salvage option for high-risk or treatment-refractory cases after other modalities, including autoSCT. CAR T-cell therapy, utilizing genetically modified T cells targeting CD19, has revolutionized relapsed/refractory FL. Products like axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel have demonstrated high response rates and durable remissions even in heavily pretreated patients with high-risk features. This potent therapy is increasingly considered a bridge between autoSCT and alloSCT, expanding treatment options. Additionally, bispecific antibodies such as mosunetuzumab, epcoritamab and odrenextamab provide convenient off-the-shelf options, exhibiting strong efficacy and favorable safety. However, their impact on subsequent CAR-T outcomes, especially with CD19-targeting bispecifics, remains an area of ongoing investigation and uncertainty. The complex interplay of these therapies necessitates individualized decisions, emphasizing patient characteristics and disease-specific factors to optimize outcomes in FL. Further research into predictive biomarkers and refined treatment algorithms is crucial for future management. Full article

Background/Objectives: Omalizumab is a monoclonal anti-IgE antibody approved for the treatment of chronic urticaria. There are no established or validated prognostic markers currently available to identify likely responders. The aim of this study was to retrospectively analyze a cohort of chronic urticaria patients treated with omalizumab, in order to determine the clinical and laboratory characteristics associated with complete response to therapy. Methods: Medical records of chronic urticaria patients receiving omalizumab were reviewed. The following parameters were collected: age, sex, disease duration, Urticaria Activity Score over 7 days (UAS7), time to response, total serum IgE levels, presence or absence of atopy, neutrophil-to-lymphocyte ratio, eosinophil and basophil counts, presence or absence of autoimmune conditions, and treatment duration. Complete response was classified as dependent on continued drug administration or drug-free (sustained remission after discontinuation). Adverse events were also recorded. Results: Omalizumab was well tolerated by all patients, with no serious adverse events reported. Complete response was achieved in 81.3% of patients; partial and no responses were observed in 8.3% and 10.1%, respectively. The majority of responders (~79.5%) maintained complete control of hives with low-dose omalizumab; subsequently, most of these patients eventually achieved sustained, drug-free remission. Total serum IgE levels appeared to predict complete response, with 164.7 IU/mL identified as the cut-off value potentially distinguishing responders from nonresponders. Conclusions: Omalizumab is a safe and effective treatment for chronic urticaria. Total serum IgE levels may help identify complete responders. Long-term low-dose regimens could be considered to reduce the economic burden on healthcare systems, although this is currently an off-label approach. Full article

Background: Acute myeloid leukemia (AML) is an aggressive and biologically diverse hematologic cancer that disproportionately affects older individuals. Despite advances in molecular profiling and therapy, long-term outcomes remain unsatisfactory. This nationwide registry was established to provide real-world insights into clinical characteristics, treatment strategies, and survival among adult AML patients in Turkey. Methods: The Turkish AML Registry Project (ClinicalTrials.gov Identifier: NCT05979675) combines retrospective and prospective data from 23 tertiary hematology centers. Adult patients diagnosed between January 2008 and July 2023 were included. Baseline demographics, European LeukemiaNet (ELN) 2017 risk groups, Eastern Cooperative Oncology Group (ECOG) performance status, treatment intensity, and targeted therapy use were analyzed. Response and survival outcomes were assessed using Kaplan–Meier methods. Results: The interim dataset included 891 patients (median age 58 years, 45.5% ≥60). Intensive chemotherapy, most commonly 7 + 3, was applied in 74.1%, while 25.9% received lower-intensity regimens. Targeted agents, mainly venetoclax, were incorporated more frequently into low-intensity therapies (19.1% vs. 3.4%, p < 0.001). Complete remission occurred in 70.2% after intensive and 35.9% after low-intensity therapy, improving to 51.4% with targeted agents. Median overall survival (OS) was 27.2 months, with 1-year OS rates of 54.1%, 28.9%, and 17.6% for favorable, intermediate, and adverse ELN groups (p < 0.001). ECOG 0–1 predicted superior survival (1-year OS 70.3% vs. 47.0%). Conclusions: Nationwide real-world evidence underscores the prognostic relevance of ELN risk and functional status in AML. While intensive chemotherapy remains central, combining targeted agents with low-intensity regimens improves outcomes in less fit patients and supports personalized treatment approaches. Full article

Background/Objectives: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease frequently complicated by hematologic abnormalities, which may reflect disease activity or treatment effects. To characterize the clinical, laboratory, and immunological features of adult SLE patients referred to hematology during routine rheumatology follow-up. Methods: We retrospectively analyzed 84 adult SLE patients who fulfilled the 2012 SLICC or 2019 EULAR/ACR criteria and were referred to hematology during follow-up. Clinical, laboratory, and immunological data were collected. Associations between hematologic manifestations, organ involvement, autoantibodies, and complement levels were evaluated. Results: The cohort included 92.6% females with a median age of 46 (IQR 36–62). Hematologic abnormalities commonly appeared within three years of disease onset. Lymphadenopathy was more frequent in patients with cutaneous vasculitis and lupus nephritis (p = 0.046 and p = 0.045). Splenomegaly was associated with serositis, anti-β2 glycoprotein I IgG, and lupus anticoagulant (LA) positivity; anti-β2GPI IgG independently predicted splenomegaly (OR 26.02, p = 0.006). Low C4 was associated with increased autoimmune hemolytic anemia risk (OR 5.88, p = 0.009), while low C3 was linked to lupus nephritis (p = 0.017). Antiphospholipid antibodies were significantly associated with venous thrombosis, with anti-cardiolipin IgG as an independent predictor (OR 7.43, p = 0.007). Stroke history, anti-histone antibodies, and higher steroid doses were associated with mortality. Remission was linked to fewer comorbidities (p = 0.008). Conclusions: Hematologic complications in SLE arise early and carry prognostic significance, with splenomegaly associated with lupus anticoagulant and anti-β2GPI IgG, and mortality linked to anti-histone antibodies. Full article

Objective: This study aimed to evaluate the prognostic value of changes in the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Visceral Adiposity Index (VAI), and Triglyceride-Glucose (TyG) index in predicting type 2 diabetes mellitus (T2DM) remission following bariatric surgery. Methods: This retrospective cohort study analyzed anthropometric, biochemical, and metabolic parameters from 66 T2DM patients who underwent bariatric surgery between 2021 and 2024. Data from the preoperative and 6-month postoperative periods were classified for diabetes remission using American Society for Metabolic and Bariatric Surgery (ASMBS) criteria. Results: The mean participant age was 49.9 ± 9.3 years; 72.7% were female. Post-surgery, 51.5% achieved complete remission, 24.25% partial remission, and 24.25% no remission. Only one patient continued insulin, and 83.8% discontinued oral antidiabetics. Significant postoperative improvements were observed in BMI, waist circumference, fasting glucose, HbA1c, triglycerides, HOMA-IR, VAI, and TyG indices, with increased HDL levels (p < 0.001). However, preoperative HOMA-IR, VAI, and TyG did not differ significantly across remission groups in univariate analyses. Multivariate logistic regression identified only younger age, higher preoperative BMI, and elevated postprandial insulin as independent predictors of complete remission. Other preoperative biochemical markers were not significantly related to remission outcomes. Conclusions: This study indicates that preoperative HOMA-IR, VAI, and TyG have limited standalone value for predicting diabetes remission after bariatric surgery. While they reflect postoperative metabolic improvements, their individual utility in pre-surgical risk stratification is insufficient. More large-scale, prospective studies are needed to determine if these markers could enhance future personalized predictive models. Full article

Background/Objectives: Psoriasis is currently treated with biologics targeting the IL-17A signaling, which plays a major role in immune response and keratinocyte hyperproliferation. These include inhibitors of IL-17A and/or its heterodimer with IL-17F (Secukinumab, Ixekinumab and Bimekizumab) and the receptor IL17-RA (Brodalumab). Although these drugs are safe and highly effective, there is significant variability in response among patients. This can be partly attributed to the patients’ genetic background, thus pointing to the need to identify pharmacogenetic markers for treatment response. Methods: The study involved 88 Greek patients who were treated with inhibitors of the IL-17A signaling for at least 6 months. Patients were classified as responders and non-responders according to the change in Psoriasis Area Severity Index. A total of 730,000 variants were genotyped and analyzed for association with the 3-month and 6-month responses to treatment. Results: The analysis identified 21 variants which were associated with the response, showing statistical significance after Bonferroni correction. These include variants located in protein coding genes (TP63, NRG1, SCN8A, TAF9, TMEM9, SMIM36, SYT14, BPIFC, SEZ6L2, PCARE), as well as intergenic and long non-coding RNA intronic variants. The functional significance of the variants was assessed using in silico analysis and for several variants, a link with immune processes was proposed. Notably, rs11649499 status, which was associated with complete clinical remission at 3 months, may influence key lipid mediators involved in psoriasis. Conclusions: This GWAS identified novel variants that could be utilized upon validation in larger populations as predictive markers regarding patient response to drugs targeting the IL-17A pathway. Full article

Background: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory breast condition that poses diagnostic and therapeutic challenges. While corticosteroids are standard first-line therapy, some patients require additional immunomodulation, such as methotrexate. Predictive factors for step-up therapy remain poorly characterized. This study aimed to identify clinical, imaging, and pathological factors predictive of step-up therapy in IGM and evaluate associations between treatment approach and outcomes. Methods: A retrospective cohort study of women diagnosed with IGM was conducted between May 2022 and June 2024 at a tertiary center in Singapore. Data on demographics, clinical presentation, imaging, histopathology, and treatment were extracted. Step-up therapy was defined as methotrexate use following corticosteroids. Primary outcome was predictors of step-up therapy; secondary outcomes included treatment success, relapse, surgery, and time to remission. Statistical analyses included chi-square/Fisher’s exact tests, Cox models, and Kaplan-Meier analysis. Results: Fifty-two women (median age 39 years) were included; 26 (50%) required step-up therapy. Predictors included oral contraceptive (OCP) use (RR 1.92; 95% CI 1.45–2.53; p < 0.001), smoking (RR 2.00; 95% CI 1.49–2.69; p < 0.001), flares (RR 2.33; 95% CI 1.44–3.79; p = 0.002), and percutaneous aspiration (RR 2.10; 95% CI 1.53–2.88; p = 0.025). Patients receiving methotrexate had lower relapse rates (RR 1.23; 95% CI 1.12–1.36; p < 0.001) but longer time to remission (adjusted HR 0.09; 95% CI 0.02–0.46; p = 0.004). Conclusions: OCP use, smoking, flares, and aspiration need may predict step-up therapy in IGM. Early identification could guide a more personalized, potentially top-down treatment. Full article

Treatment options for major depression are limited: only about one-third of patients achieve remission with first line treatments with no established predictive markers. Parameters associated with treatment refractory depression, including metabolic markers (increased BMI, increased triglyceride levels), inflammation markers (C-reactive protein, CRP), autonomic disturbances (reduced blood pressure, reduced heart rate variability), and brain morphology changes (increased volume of the choroid plexus and brain ventricle volumes), may serve such purpose. These features can be linked mechanistically to an increase in aldosterone plasma concentration due to a reduced mineralocorticoid receptor (MR) sensitivity. The primary CNS target of aldosterone is the nucleus of the solitary tract (NTS), which is also the entry point of the vagus nerve. This nucleus integrates signals from endocrine, inflammatory, chemoreceptive, and physiological parameters, including blood pressure. In search of a mechanism to overcome this pathology, we identified a molecule which is derived from the licorice plant glycyrrhiza glabra, namely glycyrrhizin and its biologically active metabolite enoxolone. These molecules potentially reverse the above-described pathology. They inhibit the enzyme 11beta hydroxysteroid-dehydrogenase type 2 (11betaHSD2) and the toll-like receptor 4 (TLR4). 11betaHSD2 regulates the activity of the mineralocorticoid receptor (MR) by degrading cortisol/corticosterone, which allows aldosterone to bind to the MR. TLR4 is the ligand for lipopolysaccharide (LPS, endotoxin) and trigger of innate immunity. Consequently, patients with increased inflammation markers, increased aldosterone, or low blood pressure may preferentially benefit from the treatment with glycyrrhizin/enoxolone. Importantly, these patients can be identified BEFORE treatment is initiated. Clinically, patients sharing these biological indicators are primarily young females or patients with a history of childhood trauma. A combination of enoxolone with standard antidepressants may therefore avoid a trial-and-error approach and allow to achieve recovery faster. Full article

Background/Objectives: Systemic lupus erythematosus (SLE) is an autoimmune disease affecting multiple organ systems, characterized by remissions and relapses. Musculoskeletal involvement occurs in up to 95% of patients and may present as the initial symptom in 50%. Such involvement is often subclinical, without obvious joint or tendon inflammation. Musculoskeletal ultrasound (US) has proven valuable for detecting pathological changes in joints and periarticular structures, including in SLE patients, and early detection, particularly in subclinical stages, supports optimal therapy, monitoring, and improved prognosis. This study aimed to determine the frequency of new clinical manifestations in patients with previously confirmed clinical and subclinical musculoskeletal inflammation after 2 and 5 years, and to evaluate associations with sex, age, BMI, smoking status, ESR, CRP, SLEDAI-2K, complement components C3 and C4, anti-dsDNA antibodies concentrations, and prior treatment. Methods: The study included 34 SLE patients with clinical and 22 with subclinical musculoskeletal inflammation, confirmed at baseline by history, examination, and US. Follow-up at 2 and 5 years recorded new clinical manifestations. Correlations with patient characteristics were assessed to identify predictors. Results: New clinical manifestations occurred in 34% of patients at 2 years and 48% at 5 years, most commonly cutaneous, musculoskeletal, and hematological. Summary analysis identified female sex, lower BMI, and lower baseline SLEDAI-2K scores as the strongest predictors. In the subclinical group, female sex, smoking, and lower SLEDAI-2K scores were predictive, while in the clinical group, female sex, lower SLEDAI-2K scores, lower ESR, and higher anti-ds DNA levels were associated with new manifestations. Conclusions: Female sex, lower BMI, and lower baseline SLEDAI-2K scores are key predictors of new clinical manifestations in SLE patients, highlighting the importance of early detection and individualized monitoring, particularly in patients with subclinical musculoskeletal inflammation. Full article

Background: Cryopreservation of hematopoietic stem cells (HSCs) at −80 °C using uncontrolled-rate freezing is frequently employed in resource-constrained settings, yet concerns remain regarding long-term viability and clinical efficacy. Reliable post-thaw assessment is essential to ensure graft quality and engraftment success. Methods: This single-center, retrospective study evaluated 72 cryopreserved stem cell products from 25 patients stored at −80 °C for a median of 868 days. Viability was assessed using both acridine orange (AO) staining and 7-AAD (7-aminoactinomycin D) flow cytometry at three time points: collection (T0), pre-infusion (T1), and delayed post-thaw evaluation (T2). Associations between viability loss, storage duration, and clinical engraftment outcomes were analyzed. Results: Median post-thaw viability remained high (94.8%) despite a moderate time-dependent decline (~1.02% per 100 days; R² = 0.283, p < 0.001). Mean viability loss at T2 was 9.2% (AO) and 6.6% (flow cytometry). AO demonstrated greater sensitivity to delayed degradation, with a significant difference between methods (p < 0.001). Engraftment kinetics were preserved in most patients, with neutrophil and platelet recovery primarily influenced by disease type rather than product integrity. Notably, storage duration and donor age were not significantly associated with engraftment outcomes or CD34⁺ cell dose. Conclusions: Long-term cryopreservation at −80 °C maintains HSC viability sufficient for durable engraftment, despite gradual decline. While transplant outcomes are primarily dictated by disease biology and remission status, AO staining provides enhanced sensitivity for detecting delayed cellular damage. Notably, our viability-loss model offers a practical framework for predicting product quality, potentially supporting graft selection and clinical decision-making in real-world, resource-constrained transplant settings. Full article

Reliable clinical markers for predicting sustained renal remission remain poorly understood in patients with lupus nephritis (LN). We investigated whether achieving complete renal remission (CRR) within 6 months of induction therapy, compared to within 12 months, was associated with a higher likelihood of attaining CRR at 24 months. We conducted a retrospective observational study of biopsy-proven patients with class III or IV ± V LN treated at a lupus clinic in Australia. CRR was defined as a urine protein: creatinine ratio (UPCR) of <0.05 g/mmol with no worsening of eGFR > 10% from baseline. CRR responders at 6, 12, and 24 months were determined. Associations between 6- and 12-month CRR status and 24-month CRR were examined using logistic regression. In total, 60 patients were included; 49 (82%) were female, with a median age of 27 years (IQR: 19, 39) at LN diagnosis. CRR was attained at 6, 12, and 24 months by 23 (40%), 26 (47%), and 24 (44%) of patients, respectively. Both 6- and 12-month CRR attainment were significantly associated with an increased likelihood of CRR achievement at 24 months (adjusted odds ratios 11.23 (95% CI 2.53, 49.88) and 11.39 (95% CI 2.41, 53.80), respectively). Achieving CRR at 6 and 12 months was a strong independent predictor for attaining subsequent renal remission. Full article

Background: Although telomere length maintenance is a common characteristic of hematological malignancies, the role of telomere length as a prognostic factor to stratify acute lymphoblastic leukemia (ALL) patients depending on their risk of relapse remains elusive. Methods: This knowledge gap motivated us to examine telomere length values in children with ALL at the time of diagnosis and after treatment using quantitative polymerase chain reaction (qPCR) (n = 35). To achieve high-resolution precision and cell specificity, a quantitative fluorescence in situ hybridization (qFISH) technique was developed (n = 5). Results: The results demonstrated statistically significant evidence of telomere shortening in the lymphoblasts of children with ALL but not in the lymphocytes of children after remission following treatment. Our findings also suggested a significant association between telomere shortening and a high risk of relapse disease. Last but not least, our preliminary results showed a trend that telomere shortening was more pronounced in children with B-ALL compared to those with T-ALL in a non-significant manner. Conclusions: Consequently, the current study provides preliminary insights into the potentially substantial prognostic value of telomere length in the progression of pediatric ALL, with the possibility of predicting treatment response. To clarify the application of telomere length as a possible biomarker for disease progression and treatment response in children with ALL, the telomere length values of additional participants need to be examined in further studies. Full article

Background: Dupilumab, a monoclonal antibody targeting the IL-4/IL-13 receptor, has shown significant efficacy in improving asthma control and reducing exacerbations in patients with severe eosinophilic asthma. However, there is a lack of knowledge about real-world data on clinical remission rates and their predictors. Objective: This study aimed to evaluate clinical outcomes, remission rates, and predictive factors of remission in a real-life cohort of patients with severe eosinophilic asthma treated with dupilumab. Methods: We conducted a retrospective, bicentric, observational study including 52 patients with severe eosinophilic asthma treated with dupilumab. Clinical, functional, and biomarkers were assessed at baseline, 6 months, and 12 months. Statistical analyses included logistic regression to identify independent predictors of clinical remission. Results: After 12 months of treatment, 48.2% of patients achieved clinical remission. Dupilumab significantly improved asthma control and lung function (including FVC and FEF_25–75), reduced exacerbation rates, and maintenance therapy. High blood eosinophil levels (>490 cells/µL), high FeNO levels (>25 ppb), a history of CRSwNP, and better baseline FEV1 were associated with asthma remission. Conversely, obesity (BMI > 30) and related comorbidities (such as GERD, OSAS, and hypertension) and bronchiectasis were associated with a lower likelihood of remission. Multivariate analysis confirmed higher baseline FEV1 (OR 2.94; IC 1.13–7.6), positive history of CRSwNP (OR 8.03; IC 1.41–45.5), and higher baseline blood eosinophils (OR 1.003 IC 1.001–1.006) as independent predictors of clinical remission. Conclusions: These results are in line with the known effectiveness of dupilumab in severe eosinophilic asthma and identified a history of CRSwNP, higher baseline FEV1, and elevated blood eosinophils as key predictors of clinical remission. These findings may contribute to a more personalized approach to treatment selection, emphasizing the importance of comorbidity assessment together with type 2 inflammation biomarkers. Further prospective studies are needed to validate these results. Full article