How Biologic Treatments Are Transforming Severe Asthma Management

Up-and-coming biologic treatments are changing the way doctors manage severe, uncontrolled asthma. Medications such as dupilumab and tezepelumab are showing the most improvement in lung function, especially in those with high type II inflammation, according to a recent report published in Biologics in Allergic/Immunologic Conditions.

Currently, there are six biologic treatments that target specific inflammation in the body, helping patients with hard-to-control asthma breathe better and reduce flare-ups. Each offers a more personalized care compared to traditional inhalers or steroids.

These six key biologics include: omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab and Tezepelumab.

Researchers at Brigham and Women’s Hospital Harvard Medical School looked at clinical trials and compared these biolgics to placebos to see how their treatments improve and manage severe asthma.

Omalizumab, dupilumab, and tezepelumab all help improve lung function in those with asthma and reduces asthma attacks, especially if they have high type II inflammation, as type II plays a key role in asthma, particularly in allergic asthma.

Omalizumab blocks IgE, which causes allergic reactions, and improves lowering asthma attacks, but it doesn’t improve breathing as much.

Dupilumab and tezepelumab are better at improving breathing by blocking proteins (IL-4 and IL-13) that cause airway inflammation. Tezepelumab works by targeting a Thymic Stromal Lymphopoietin (TSLP) molecule that triggers the immune response, helping to reduce asthma attacks and improve lung function.

Other biologics such mepolizumab and benralizumab help those who have many eosinophils — a type of white blood cell — cut down on steroids too.

Although there are still unanswered questions about safely discontinuing inhalers in stable patients, combining biologics, the impact of early intervention on long-term outcomes, and the lack of direct comparisons between severe asthma treatments, scientists are exploring new approaches like the Precision Medicine in Severe and/or Exacerbation Prone Asthma (PrecISE) trial.

This trial uses precision medicine to match treatments to patients based on their specific biomarkers.

Overall, biologics are providing those with severe asthma more control of their symptoms and fewer side effects, but there’s still more to learn.

Researchers are looking into whether these treatments could lead to long-term remission and how they might impact asthma in the future. With further studies, their hope is to make care even more personalized and effective for those living with severe asthma.