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Despite advances in mAb therapies, some SEA patients continue to experience uncontrolled symptoms. Understanding these factors could lead to more effective, personalized treatment strategies. Participants diagnosed with SEA and undergoing mAb therapy for 6-9 months were recruited from three German university outpatient clinics. They were categorized using the Biologics Asthma Response Score (BARS) into responders, partial responders, and non-responders. Data collection focused on demographic details, lung function, medication history, patient activation (PAM13-D), and adherence (A14 questionnaire). Statistical analyses assessed the impact of adherence and knowledge on treatment outcomes. Of the 140 participants, 61% were responders, 24% partial responders, and 15% non-responders. Age, sex distribution, smoking status, pack-years, eosinophil levels, ExNO and lung function parameters were comparable across response groups. A14 scores and asthma knowledge differed significantly across response groups, whereas PAM13-D did not. In ordinal logistic regression, asthma knowledge remained associated with BARS-defined response category after adjustment. A negative attitude towards drugs was associated with response category in univariate analysis, but this association was attenuated after adjustment. Better asthma knowledge was associated with BARS-defined response to mAb therapy, while PAM13-D and overall A14 score were not independently associated with response. Medication attitude may still be clinically relevant, but their association with response should be interpreted cautiously. These findings support a patient-centered approach that considers asthma knowledge, adherence-related behaviors and medication attitudes during biologic treatment. Prospective studies are needed to determine whether targeted education and adherence support can improve clinical outcomes.<\/jats:p>","DOI":"10.1038\/s41598-026-64363-5","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:46:39Z","timestamp":1785512799000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relationship between knowledge, adherence-related behaviors and self-management with response to monoclonal antibody therapy in patients with severe asthma"],"prefix":"10.1038","volume":"16","author":[{"given":"Christopher Alexander","family":"Hinze","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Valtin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Trinkmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Milger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Drick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik","family":"Suhling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2926-3608","authenticated-orcid":false,"given":"Jan","family":"Fuge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"64363_CR1","unstructured":"Lommatzsch M, Cri\u00e9e CP, de Jong CCM, Gappa M, Ge\u00dfner C, Gerstlauer M, et al. 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Vincent M\u00fcller has nothing to declare. Christina Valtin has nothing to declare. Frederik Trinkmann received travel support from Actelion, Berlin Chemie, Boehringer Ingelheim, Chiesi, Novartis, Mundipharma, TEVA AstraZeneca, Berlin Chemie, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, GlaxoSmithKline, Novartis and Roche, and Sanofi-Aventis, all outside the submitted work. Katrin Milger-Kneidinger reports personal fees and speaker fees from AstraZeneca, AOP, Boehringer Ingelheim, Chiesi, GSK, Ferrer, Janssen, Novartis, and Sanofi, all outside the submitted work. Nora Drick has nothing to declare. Hendrik Suhling reports personal fees from AstraZeneca, GSK, and Sanofi, all outside the submitted work. Jan Fuge has nothing to declare.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with ethical guidelines and approved by the institutional review board of Hannover Medical School Number (10624_BO_K_2022 and Nr. 2923-2015). Informed consent was obtained from all participants prior to their inclusion in the study.","order":2,"name":"Ethics","label":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"23716"}}