Among patients with severe asthma, the need for biologic therapy varies by clinical stage. Mepolizumab is the preferred choice.

A systematic literature review, presented at the 2023 ERS International Congress, revealed that two out of three patients with ERS/ATS-defined severe asthma are suitable candidates for biologic treatment. Mepolizumab emerged as the preferred biologic medication worldwide.

Patients with severe asthma receive biologic therapies when their response to conventional treatments fails. However, the regulations and guidelines to introduce biologic therapy vary in different countries, influencing its initiation.

Freda Yang, MD, and her team conducted a systematic review to determine the prevalence of biologic candidates among asthma patients globally. They performed a literature search using MEDLINE, EMBASE, and ClinicalTrials.gov, selecting studies published from 2000-2022 that focused on adult patients with asthma who were eligible for biologic therapy using monoclonal antibodies, including mepolizumab, omalizumab, benralizumab, reslizumab, dupilumab, or tezepelumab.

Studies including children (≤ 11 years), those receiving biologics, or those assessing eligibility without biomarker assessment were excluded.

Out of 429 identified records from this search, only 15 articles met the eligibility criteria for analysis after removing duplicates, screening the records, and assessing the articles. Among the 10,165 patients with asthma in these 15 observational studies, 29.4% (n=2989) had European Respiratory Society/American Thoracic Society (ERS/ATS)–defined severe asthma, which was confined to 10 studies.

The prevalence of biologic-eligible patients among those with ERS/ATS–defined severe asthma was 24.1% to 91.4%. Higher proportions were noted when oral corticosteroid use was not a criterion.

Five studies recorded patients with mild to moderate asthma, and the prevalence of biologic-eligible patients in these studies ranged from 1.4% to 19.7%. Similarly, three studies reported patients with difficult-to-treat asthma, where eligible patients varied from 13.1% to 55%.

The order of preference of medicaments in biologic therapy was mepolizumab (median proportion (MP): 35.5%; range (r): 2.2-78%), followed by omalizumab (MP: 28.1%; r: 1.6-66%), benralizumab (MP: 25.5%; r: 1.3-53%), and reslizumab (MP: 24.4%; r: 0.5-41%).

The authors concluded that globally, the need for biologic therapy among patients with asthma varies according to the clinical stage of the disease, with higher demand in cases of ERS/ATS–defined severe asthma. Mepolizumab is the biologic most frequently used worldwide.

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