Work

Real-world effectiveness of asthma biologics by age of initiation and early-childhood risk factors

Year: 2026

Type: article

Abstract: BACKGROUND: While several biologics are approved in the United States for the treatment of severe asthma in children aged ≥6 years, important knowledge gaps persist regarding their real-world effectiveness. Here, we examine their real-world effectiveness and whether it differs by age of treatment initiation, biologic agent, or early-childhood asthma risk factors and characteristics. METHODS: Retrospective cohort of 122 children with moderate/severe asthma treated with a biologic by pediatric subspecialists between December 2019 and December 2024. Piecewise generalized linear mixed-effects models were used to examine biologic clinical benefit, defined as the change in the odds of severe asthma exacerbations before versus after treatment initiation. RESULTS: The cohort (52% female, 59% African American, mean age 10 ± 4 years at biologic initiation) was prescribed dupilumab (64%), omalizumab (29%), or mepolizumab (8%) and had 10 years median follow-up. Biologics led to significant reductions in severe exacerbations (adjusted OR = 0.47 [95% CI = 0.28, 0.80]); this benefit was more pronounced with younger age at initiation: aOR = 0.46 [95% CI = 0.26, 0.80] in ≤11-year olds, vs aOR = 0.56 [95% CI: 0.27, 1.89] in those ≥12 years. Similarly, benefit was more pronounced among patients with early-childhood polysensitization (aOR = 0.32 [95% CI = 0.14, 0.74]) than those without (aOR = 0.59 [95% CI = 0.30, 1.19]) and patients with a moderate/high burden of early-childhood asthma risk factors (aOR = 0.39 [95% CI = 0.21, 0.70]) than those with low burden (aOR = 0.90 [95% CI = 0.32, 2.57]). We found no significant differences by biologic agent. CONCLUSION: Biologics may be more effective with earlier treatment initiation, especially among children with early polysensitization or multiple early-childhood risk factors. Screening for these risk factors may help inform targeted early initiation of biologics for asthma.

Source: Annals of the American Thoracic Society

DOI: 10.1093/annalsats/aaoag019