ReviewChest2025
Choosing the Right Biologic for the Right Patient With Severe Asthma.
Review in Chest, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Inflammatory and clinical risk factors for asthma attacks (ORACLE2): a patient-level meta-analysis of control groups of 22 randomised trials.The Lancet. Respiratory medicine · 2025Pooled it
- Pooled it
- Consistent adherence to biologic therapies is critical for improving outcomes in asthma.The journal of allergy and clinical immunology. Global · 2026Article
- Clinical diagnosis and treatment of eosinophilic asthma by respiratory physicians in China: a cross-sectional survey.Journal of thoracic disease · 2026Article
- Update in asthma management: A narrative review of recent advances, challenges, and future directions.Clinical medicine (London, England) · 2026Review
- Real-world characterisation of severe asthma in Greece: results from the Greek Severe Asthma Registry.ERJ open research · 2026Article
- Type 2 inflammation, bronchiectasis and clinical trials: expanding from MAHALE.ERJ open research · 2026Article
- Targeting the Epithelial Alarmin Pathway with Tezepelumab in Highly Comorbid, Biologic-Experienced Severe Asthma: 52-Week Real-World Outcomes.Journal of clinical medicine · 2026Article
- Review
- Triggering mechanisms of acute thunderstorm asthma: epithelial barrier disruption and immune dysregulation.Respiratory research · 2026Review
- Benralizumab in Severe Eosinophilic Asthma: Toward Disease Control and Evolving Treatment Paradigms.Journal of inflammation research · 2026Review
- Airway epithelial dysfunction in asthma pathogenesis: epigenetic mechanisms, inflammatory crosstalk, and therapeutic opportunities.Frontiers in allergy · 2026Review
- Integrated Single-Cell Profiling Reveals TL1A as a Biomarker and Driver of Type 2 Inflammation via Macrophage-Dependent Immunoregulation in Asthma.Research (Washington, D.C.) · 2026Article
- Biologic Therapies in Severe Asthma and Eosinophilic Granulomatosis with Polyangiitis: Targeted Therapy and Personalized Care.Tuberculosis and respiratory diseases · 2026Article
- Choosing and switching biologics for patients with severe asthma: Real-world data from the German Asthma Net (GAN).Allergologie select · 2026Article
- The frequency and predictability of switching biologic agents in severe asthma: A real-world perspective.Asia Pacific allergy · 2025Article
- Integrating blood eosinophils and exhaled nitric oxide (FeNO) in asthma diagnostic pathways for adults and children: the PROPULSION SANTÉ observational study with translational sub-studies (DIVE, DIVE2)-protocols.BMJ open respiratory research · 2025Article
- What Sex-Specific Differences Tells Us About Additive vs Synergistic Risk Prediction in Asthma.CHEST pulmonary · 2025Article
- Recent evidence for stepping down severe asthma therapies.Current opinion in pulmonary medicine · 2025Review
- Phenotyping the responses to systemic corticosteroids in the management of asthma attacks (PRISMA).The European respiratory journal · 2025Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In this installment of the How I Do It series on severe asthma, we tackle the clinical conundrum of choosing the right biologic for the right patient with severe asthma. With six biologics now approved for use in this area comprising four different targeting strategies (anti-Ig E: omalizumab; anti-IL-5 and anti-IL-5-receptor: mepolizumab, reslizumab, and benralizumab; anti-IL-4-receptor: dupilumab; anti-thymic stromal lymphopoietin: tezepelumab), this question is increasingly complex. Recognizing that no head-to-head trial has compared biologics, we based our review on the expected effects of inhibiting different aspects of type 2 airway inflammation, supported whenever possible by clinical trial and real-world data. We use four variations of a case of severe uncontrolled asthma to develop concepts and considerations introduced in the previous installment ("Workup of Severe Asthma") and discuss pregnancy-related, biomarker-related, comorbidity-related, and corticosteroid dependency-related considerations when choosing a biologic. The related questions of deciding when, why, and how to switch from one biologic to another also are discussed. Overall, we consider that the choice of biologics should be based on the available clinical trial data for the desired efficacy outcomes, the biomarker profile of the patient, safety profiles (eg, when pregnancy is considered), and opportunities to target two comorbidities with one biologic. Using systemic and airway biomarkers (blood eosinophils and exhaled nitric oxide [Feno]) and other phenotypic characteristics, we suggest a framework to facilitate therapeutic decision-making. Post hoc studies and new comparative studies are needed urgently to test this framework and to determine whether it allows us to make other clinically useful predictions.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.