ArticleAnnals of the American Thoracic Society2026
Real-world effectiveness of asthma biologics by age of initiation and early-childhood risk factors.
Article in Annals of the American Thoracic Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhile several biologics are approved in the United States for the treatment of severe asthma in children aged ≥6 years, important knowledge gaps persist regarding their real-world effectiveness. Here, we examine their real-world effectiveness and whether it differs by age of treatment initiation, biologic agent, or early-childhood asthma risk factors and characteristics.
methodsRetrospective cohort of 122 children with moderate/severe asthma treated with a biologic by pediatric subspecialists between December 2019 and December 2024. Piecewise generalized linear mixed-effects models were used to examine biologic clinical benefit, defined as the change in the odds of severe asthma exacerbations before versus after treatment initiation.
resultsThe cohort (52% female, 59% African American, mean age 10 ± 4 years at biologic initiation) was prescribed dupilumab (64%), omalizumab (29%), or mepolizumab (8%) and had 10 years median follow-up. Biologics led to significant reductions in severe exacerbations (adjusted OR = 0.47 [95% CI = 0.28, 0.80]); this benefit was more pronounced with younger age at initiation: aOR = 0.46 [95% CI = 0.26, 0.80] in ≤11-year olds, vs aOR = 0.56 [95% CI: 0.27, 1.89] in those ≥12 years. Similarly, benefit was more pronounced among patients with early-childhood polysensitization (aOR = 0.32 [95% CI = 0.14, 0.74]) than those without (aOR = 0.59 [95% CI = 0.30, 1.19]) and patients with a moderate/high burden of early-childhood asthma risk factors (aOR = 0.39 [95% CI = 0.21, 0.70]) than those with low burden (aOR = 0.90 [95% CI = 0.32, 2.57]). We found no significant differences by biologic agent.
conclusionBiologics may be more effective with earlier treatment initiation, especially among children with early polysensitization or multiple early-childhood risk factors. Screening for these risk factors may help inform targeted early initiation of biologics for asthma.
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