Precision medicine and choosing a biologic in asthma: understanding the current state of knowledge for predictors of response and clinical remission.

Abstract

We review updated key literature on comparative meta-analyses and real-world effectiveness of asthma biologics, with a focus on predictors of response and clinical remission while highlighting ongoing knowledge gaps. We aim to provide insight into the many factors to consider when choosing a biologic to treat uncontrolled moderate to severe asthma. Predictors of response included higher type 2 (T2) biomarkers, shorter duration of asthma, and presence of key T2-related comorbidities. There were outcome-related variations in predictors. Predictors of clinical remission included better controlled asthma, better lung function, and higher T2 biomarkers. Few real-world studies included those treated with tezepelumab, a clear knowledge gap. Asthma biologics demonstrate clear real-world effectiveness. There have been significant strides in better understanding predictors of response or clinical remission to guide management, yet ongoing knowledge gaps and the heterogeneity of asthma preclude a simple algorithmic approach. Our tools for precision medicine include consideration of clinical phenotypes and shared decision making while striving to achieve clinical remission in all our patients with asthma.