Predictors of Response to Biologics for Severe Asthma: A Systematic Review and Meta‐Analysis
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Biologics are effective for severe asthma, but not all patients benefit equally. There is an urgent need to understand which biologic works best for which patient. We systematically searched for predictors of response to biologics (except omalizumab) for severe asthma in four bibliographic databases and two trial registries from 1990 to 2024. Two reviewers screened records, extracted data, and assessed risk of bias using a modified CASP checklist. Data were synthesized narratively, and certainty of evidence assessed using the modified GRADE framework. Comparable studies were meta-analyzed using a random-effects model. From 5853 records, 21 studies were identified investigating predictors of anti-IL5/5Rα, 4Rα, and anti-TSLP response. We found predominantly 'moderate' to 'high' quality evidence that raised blood eosinophil counts (≥ 300 cells/μL), FeNO levels (> 40 ppb), lack of or low OCS dose (< 10 mg/day), and better asthma control predict biologic response. Evidence for the predictive value of other characteristics was limited and mostly 'low' quality. Key reasons for downgrading the evidence were heterogeneous response definitions and imprecision. No data were identified for the pediatric population or biologics targeting the non-T2 pathway. Outside of traditional inflammatory and clinical variables, there is an unmet need for universally applicable predictors of biologic response for severe asthma.
Source: Allergy
DOI: 10.1111/all.70031
Authors: Anna Rattu, Piers Dixey, David Charles, Chris Brightling, Kian Fan Chung, Apostolos Bossios, Arnaud Bourdin, Ratko Djukanovic, Sven‐Erik Dahlén, Louise Fleming, Rekha Chaudhuri, Erik Melén, Antoine Deschildre, Charles Pilette, Gerard H. Koppelman, Andrew Exley, Freja Anckers, Sarah Miller, Hanna Nielsen, Clare Williams, Ekaterina Khaleva, Graham Roberts
Institutions: University Hospital Southampton NHS Foundation Trust, NIHR Southampton Biomedical Research Centre, University of Southampton, Royal Brompton Hospital, Imperial College London, Southampton General Hospital, University of Leicester, NIHR Leicester Biomedical Research Centre, Karolinska University Hospital, Karolinska Institutet, Université de Montpellier, Physiologie et Médecine Expérimentale du Coeur et des Muscles, Imperial College Healthcare NHS Trust, University of Glasgow, Stockholm South General Hospital, Université de Lille, Centre Hospitalier Universitaire de Lille, Center for Infection and Immunity of Lille, Hôpital Jeanne de Flandre, Cliniques Universitaires Saint-Luc, University Medical Center Groningen, University of Groningen, Beatrix Kinderziekenhuis, Falun Hospital, European Lung Foundation, Royal Hampshire County Hospital
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,300
Funders: AstraZeneca, GlaxoSmithKline, Sanofi, Teva Pharmaceutical Industries, Regeneron Pharmaceuticals, University Hospital Southampton NHS Foundation Trust, European Federation of Pharmaceutical Industries and Associations, Aimmune Therapeutics, Celltrion, National Institute for Health and Care Research, University of Southampton, Imperial College London, European Commission, University of Glasgow, Rijksuniversiteit Groningen, Karolinska Institutet, Universitair Medisch Centrum Groningen, Vlaamse regering, National Institute for Health Research Southampton Biomedical Research Centre, Genentech, Medical Research Council, Engineering and Physical Sciences Research Council, Cliniques Universitaires Saint-Luc
OpenAlex ID: W4414243740