Severe mixed asthma: multiple treatment options, difficult selection

Published online April 2, 2025

Severe asthma is associated with high mortality, morbidity, and burden for patients and their families. With the advent of several biologic therapies, clinical control is possible. However, specialists now face the difficulty of choosing the best therapy for each patient, especially in mixed asthma where eosinophilic and allergic endotypes overlap.

In a recently published article in The Journal of Allergy and Clinical Immunology: In Practice, Sánchez J, et al. compared four biological therapies in patients with severe mixed asthma. In this study, they evaluated various clinical control parameters but also aspects that could influence the selection of one therapeutic alternative over another.

From this study, some characteristics of each biologic could be analyzed and could contribute to the selection of therapy for each patient; after 1 year with biologic therapies, all four groups had significant improvements in clinical outcomes with few between-group differences. Dupilumab and mepolizumab demonstrated a higher interval improvement in FEV1 compared with omalizumab. Dupilumab users had the highest proportion of patients who achieved a 200-mL improvement in FEV1 over omalizumab and benralizumab. The greatest adherence was observed among benralizumab users.

In conclusion, the four therapies present some differences in terms of some clinical parameters that could be useful for selecting which may be the best treatment alternative in severe mixed asthma based on the characteristics of each patient.

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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