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Factors to Consider in Prescribing Asthma Biologic Therapies to Children
William C Anderson1, Tina M Banzon2, Bo Chawes3
1Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
Insights
Biologics offer new severe asthma treatments for children and adolescents, but evidence is limited. Shared decision-making and careful monitoring are crucial for effective use in pediatric severe asthma management.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Pharmacology
Background:
- Biologic therapies are increasingly available for severe asthma in children and adolescents.
- Evidence for biologic efficacy and safety in pediatric populations is less robust than in adults.
Purpose of the Study:
- To review the current evidence and considerations for using biologics in pediatric severe asthma.
- To highlight the importance of a comprehensive approach before and during biologic therapy.
Main Methods:
- Literature review of studies on biologics for severe asthma in children and adolescents.
- Analysis of clinical guidelines and expert consensus statements.
- Discussion of shared decision-making principles and treatment monitoring.
Main Results:
- Limited evidence exists for biologics in pediatric severe asthma compared to adults.
- Pre-treatment evaluation of asthma diagnosis, comorbidities, and adherence is essential.
- Shared decision-making should balance efficacy, administration, and patient-specific factors.
Conclusions:
- Biologics represent a growing option for pediatric severe asthma, requiring careful patient selection and monitoring.
- Further research is needed on long-term outcomes and the role of biologics in disease remission.
- Optimizing biologic use involves a multidisciplinary approach and ongoing evaluation.
Abstract:
The increasing availability of biologics, both by expanding age indications and by development of new therapies, provides additional options to treat children and adolescents with severe asthma. However, the evidence for these biologics in these populations is limited compared with that for adult studies. As such, before initiation of therapy, possible alternative therapies that can also provide asthma control, confirmation of the diagnosis of asthma, management of comorbidities, and assessment of adherence should be explored. The choice of a biologic should be a shared decision-making process between providers and families, balancing biologic efficacy, goals of care, administration, and ability to treat multiple conditions. Response to treatment should be periodically evaluated not only to ensure an ineffective treatment is not continued but also to consider when to potentially discontinue therapy should it be beneficial. The utilization of biologics in children and adolescents with severe asthma also leads to unanswered questions on their role in disease remission and long-term outcomes.
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