Biologics associated with improved long-term lung function and asthma control, finds research

A new study published in the journal of Respiratory Investigation showed that in actual clinical practice, starting a biologics (BIOs) was linked to notable improvements in long-term lung function and asthma control in individuals with severe uncontrolled asthma.

Treatment for severe asthma, which is defined by impaired lung function, involves the use of high-dose inhaled corticosteroids (ICS) in conjunction with other controls. Severe asthma patients are more likely to experience asthma flare-ups, which hasten the deterioration of their lung function. Biologics (BIOs) have been shown to be beneficial in treating severe asthma in phase III studies and reports of actual clinical practice.

International clinical guidelines for severe asthma now include a number of BIOs that have been licensed in Japan. However, comparisons to before and after the start of BIOs were limited since the phase III trials had stringent inclusion/exclusion criteria and the real-world evidence was restricted to observations lasting up to a year with a single arm. Thus, this trial examined the long-term, 24-month efficacy of starting a BIO in individuals who were considered candidates for BIO treatment and had severe, uncontrolled asthma.

In Japan, individuals with severe uncontrolled asthma were recruited for the multicenter observational cohort research PROSPECT. The patients were split into two groups based on whether they started a BIO within 12 weeks of enrollment (BIO group) or not (non-BIO group). The doctors selected the BIO (omalizumab, benralizumab, mepolizumab, and dupilumab) based on the asthma profile of the patients.

A total of 285 of the 306 patients that were recruited (n = 125 in the BIO group and 160 in the non-BIO group) were included in the whole analysis set. In the BIO and non-BIO groups, the adjusted least-squares mean change in post-bronchodilator forced expiratory volume in 1 s at 24 months was 0.17 L and 0.04 L, respectively. The BIO group saw much larger improvements from baseline to 6, 12, and 18 months.

The BIO group showed a greater rate of oral corticosteroid withdrawal, a decrease in daily oral corticosteroid dosages, an increase in 5-item Asthma Control Questionnaire scores, and a decrease in asthma exacerbations. Overall, the current study found that patients with severe uncontrolled asthma who started a BIO in actual clinical practice saw notable improvements in long-term lung function, asthma exacerbation, and asthma control.

Source:

Asai, K., Iwanaga, T., Takahashi, M., Eda, M., Hirai, T., Yabuta, T., Makita, N., & Tohda, Y. (2025). Long-term, real-world effectiveness of biologics for severe uncontrolled asthma: The PROSPECT study. Respiratory Investigation, 63(3), 444–452. https://doi.org/10.1016/j.resinv.2025.03.007