[Biologics in severe childhood asthma]

Severe asthma in children remains relatively rare. It is no longer considered as a single disease but rather as a syndrome corresponding to different phenotypes and distinct pathophysiological pathways. Various biomarkers can contribute to phenotyping, essentially specific IgE test results, blood eosinophil counts, the exhaled fraction of NO (FeNO) assay, as well as deep lung biomarkers from induced sputum, bronchoalveolar lavage or bronchial biopsy.

In children, the biologics currently approved for severe asthma are omalizumab, mepolizumab and dupilumab from the age of 6, and tezepelumab from the age of 12.

Benralizumab and tezepelumab offer promising perspectives and a pediatric extension could be of interest in future treatment of severe pediatric asthma.

Based on physiopathological mechanisms, biologics represent a new and promising approach in the treatment of asthma. That said, the long-term efficacy and impact of these treatments on the natural history of the disease require further investigation. It is of paramount importance to take into account the specificities of pediatric asthma and, more particularly, to conduct clinical trials in younger patients.