CHEST Guidelines-Choosing-the-Right-Biologic-for-the-Right-Patient-

Choosing-the-Right-Biologic-for-the-Right-Patient-

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This document reviews the complex decision-making process in selecting the right biologic for patients with severe asthma. Authors Simon Couillard, David J. Jackson, Ian D. Pavord, and Michael E. Wechsler explore considerations for choosing from six approved biologics targeting four different immune mechanisms: omalizumab (anti-IgE), mepolizumab, reslizumab, benralizumab (anti-IL-5/receptor), dupilumab (anti-IL-4-receptor), and tezepelumab (anti-TSLP). <br /><br />The authors utilize case studies to demonstrate decision-making factors, including asthma phenotypes, biomarker profiles (e.g., blood eosinophils, FENO), patient-specific considerations (e.g., pregnancy), and therapeutic outcomes. Patients often fit into type 2 high or low inflammation categories, impacting treatment response and risks. For instance, patients with high levels of inflammatory biomarkers might require different biologics compared to those with low biomarker levels.<br /><br />The discussion underscores the lack of direct head-to-head studies comparing biologics, which complicates treatment decisions. Therefore, the choice often hinges on indirect data comparisons, patient comorbidities, and biomarker analysis. For pregnant patients, considerations of drug safety profiles are prioritized.<br /><br />Moreover, they address the decision of switching biologics if another loses efficacy. They call for further research and post hoc studies to optimize patient-specific biologic choices, recognizing that adherence management and understanding asthma phenotypes are crucial. The document concludes that careful clinical and real-world data interpretation is necessary to improve biologic therapy outcomes for severe asthma patients.

Keywords

severe asthma

biologics

decision-making

asthma phenotypes

biomarker profiles

inflammatory biomarkers

drug safety

treatment response

clinical data

real-world data