Use of Biologics in Asthma Not Linked to Higher Risk of Respiratory Infections, Finds Study
USA: Data presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology (February 27–March 2, 2026, Philadelphia) has revealed that the use of biologic therapies for asthma was not associated with an increased risk of respiratory infections. The findings suggest that these treatments remain a safe option for managing asthma without raising infection risk.
Biologic therapies are increasingly used for patients with moderate to severe asthma, especially those with type 2 inflammation who remain symptomatic despite standard treatment. These targeted drugs improve asthma control and reduce exacerbations. However, since they act on immune pathways, concerns have been raised about a possible increased risk of respiratory infections.
To investigate this, researchers led by Taha Al-Shaikhly from Penn State College of Medicine conducted a retrospective population-based study using the TriNetX US Collaborative Network, a large real-world healthcare database.
The study included patients aged 12 years or older with moderate or severe persistent asthma receiving medium-to-high doses of inhaled corticosteroids along with long-acting beta agonists. Biologic exposure was defined as treatment with dupilumab, omalizumab, anti–IL-5 agents, or tezepelumab within three months of asthma diagnosis, while patients not receiving biologics served as controls.
Researchers applied 1:1 propensity score matching to balance the two groups for demographics and comorbidities. They then assessed the three-year risk of respiratory infections, including upper respiratory tract infections, sinusitis, pneumonia, and other lower respiratory infections, using hazard ratios and confidence intervals.
The study led to the following findings:
- After propensity score matching, use of asthma biologic therapies was not associated with an increased risk of respiratory tract infections.
- The analysis showed a modest reduction in the risk of pneumonia among patients receiving biologic treatment.
- Overall, biologic therapy was associated with a lower likelihood of pneumonia compared with non-biologic treatment.
- Dupilumab use was linked to a lower probability of pneumonia.
- Dupilumab was also associated with a reduced risk of other lower respiratory infections.
- Anti–IL-5 therapies were associated with a decreased risk of pneumonia.
- No increased risk of respiratory infections was observed with omalizumab.
- Tezepelumab use was also not associated with a higher infection risk.
These findings provide reassuring evidence regarding the safety profile of biologic therapies in asthma management. The researchers concluded that, in real-world clinical practice, biologic treatments for asthma do not appear to increase the risk of respiratory infections. Moreover, some biologic agents—particularly dupilumab and anti–IL-5 therapies—may even be associated with a reduced incidence of pneumonia.
The authors note that these results support the continued use of biologic therapies as an effective and safe option for patients with moderate to severe asthma who require advanced treatment strategies.
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