Are all targeted asthma biologics equal?

Published: February 27, 2024

Asthma biologics are novel therapies that target the underlying airway inflammation that drives the symptoms of asthma. Over the past 2 decades, an increasing number of asthma biologics have become readily available offering patients with uncontrolled severe asthma a chance to live a better quality of life, decreasing their need to seek urgent medical attention for worsening asthma symptoms or asthma attacks, and reducing their need for systemic steroid treatment which can be debilitating to their health. Currently, there are 6 biologics including mepolizumab, reslizumab, benralizumab, dupilumab, omalizumab, and tezepelumab which target different aspects of airway inflammation. Unfortunately choosing between these biologics remains challenging for clinicians and patients as there are no head-to-head comparison studies between these biologics.

In a study published in The Journal of Allergy and Clinical Immunology: In Practice, Al-Shaikhly and colleagues conducted a retrospective analysis of a nationwide US claims-based database (the MarketScan Commercial Claims and Encounters Database from Merative) and assessed the real-world impact of using asthma biologics on asthma attacks. The authors also wondered whether the different asthma biologics would offer an advantage over each other in terms of reducing asthma attacks especially given these biologics are known to target different aspects of the airway inflammation. In their comparison analyses, authors were able to control for various demographics and health conditions that might influence asthma control. They also controlled for baseline asthma burden and medication utilization.  

The authors identified 5,538 patients who were new to taking an asthma biologic (omalizumab, mepolizumab, reslizumab, benralizumab, or dupilumab). The authors confirmed the effectiveness of asthma biologics in reducing asthma attacks and decreasing healthcare utilization such as emergency department visits (~32%-59% reduction) and hospitalization (~45-60% reduction) because of asthma, especially among those with high frequency of asthma attacks before starting the biologic agent. After controlling for baseline health conditions, asthma medications, and asthma attacks, the authors noted a slight advantage for using dupilumab over other biologics in reducing the odds of developing an asthma attack. The authors purposed that their findings may assist clinicians in deciding between asthma biologics, complementing their current phenotype-driven approach. A limitation of the study was that it was not able to control for biomarkers that are known to influence asthma attacks and the effectiveness of these biologics.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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