Optimizing Asthma Biologics: New Recommendations for Clinicians

For the approximately 5% to 10% of asthma patients living with severe disease, treatment can be both complex and costly.

While biologic therapies have become a cornerstone for those unresponsive to standard treatments, selecting the right agent remains a clinical challenge—one compounded by varying mechanisms of action, differences in efficacy, and a notable lack of head-to-head trials. In response, a new evidence-based review offers clinicians clearer guidance on how to approach this increasingly common therapeutic crossroad.

A panel of experts conducted a rigorous systematic review to address one key question: how can physicians optimize the use of biologic agents in adults with severe asthma? Using the widely adopted PICO framework—Population, Intervention, Comparator, and Outcome—the team developed seven critical clinical questions targeting the selection of biologics for patients aged 18 and older. Each question guided a methodical literature search spanning multiple databases, including MEDLINE, EMBASE, Web of Science, and CINAHL.

Articles that met inclusion criteria were assessed for quality and underwent pooled data analysis. The outcome was seven graded, evidence-based recommendations aimed at supporting decision-making in the absence of robust comparative data.

Notably, the panel found that factors such as baseline lung function, frequency of exacerbations, ongoing need for oral corticosteroids, biomarkers, comorbid conditions, and the specific asthma endotype all significantly influence biologic selection. Quality of life impairment also emerged as a clinically relevant consideration. Together, these patient characteristics form a framework that can help tailor therapy more precisely to individual needs.

Still, the authors underscore a critical limitation: the current evidence base is hampered by a lack of direct comparative effectiveness trials between biologic agents. This leaves clinicians reliant on indirect comparisons and subgroup analyses when navigating a biologic landscape that includes agents targeting IgE, IL-5, IL-4/IL-13, and other immune pathways.

While the review represents an important step toward standardized biologic selection, the panel calls for additional high-quality trials to better delineate the comparative benefits and risks of available options. Until then, the guidance reinforces the need for a personalized approach—one that balances clinical data with nuanced patient characteristics and shared decision-making.

As the arsenal of biologic agents continues to expand, efforts like this systematic review are vital in helping clinicians make more confident, informed choices for patients whose disease often demands more than standard therapy can offer.