Biologics free severe asthma patients from the harmful steroid grip

Published online April 26, 2025

Asthma is a very common chronic airway disease, with about 1 in 10 patients having severe asthma and facing substantial health burdens and medical costs. Nearly half of severe asthma patients suffer frequent asthma attacks and take oral corticosteroids (OCS) for relief. Around 10–15% even use long-term daily OCS to prevent flare-ups. But taking OCS– even in small doses that add up over time – can lead to numerous serious adverse health events. Doctors strongly recommend reducing or stopping OCS use in severe asthma. In the recent decades, new “biologic” treatments have been developed to precisely treat severe asthma. Although biologics greatly reduce asthma attacks and OCS intake in clinical trials, real-world evidence is limited. 

In a recent issue of The Journal of Allergy and Clinical Immunology: In Practice, a large international study by Chen et al. looked at over 5,600 adults with severe asthma from both specialist clinics and general practices in 22 countries. They wanted to see how well biologic treatments help patients reduce their OCS use in real-world medical settings. Chen et al. tracked how much the total OCS dose (including bursts for asthma attacks and daily long-term use) went down in the first and second year after starting a biologic. However, patients not on biologics might also reduce OCS intake over time. To obtain reliable findings, they carefully matched biologic users with similar patients who didn’t receive biologics – those of almost the same age, sex and asthma conditions – so that the comparison was fair. 

This study showed compelling real-world evidence that biologic treatments can greatly reduce the total steroid intake in patients with severe asthma. Patients who started biologics were more than twice as likely to cut their daily steroid dose by over 75% or stop taking them completely in the first year, compared to similar patients who did not use biologics. The benefits remained strong into the second year and were consistent when researchers tested the findings across countries and settings. These findings support the importance of starting biologic therapy early and closely monitoring patients in the first year to safely reduce their reliance on OCS.

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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