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Recent evidence for stepping down severe asthma therapies
Eric Merrell1,2, Sandhya Khurana1,2
1Division of Pulmonary and Critical Care Medicine, University of Rochester School of Medicine and Dentistry.
Current Opinion in Pulmonary Medicine
|February 28, 2025
Summary
Biologic therapies are effective for severe asthma, but stepping down treatment requires more guidance. Emerging evidence and assessment tools can help clinicians safely reduce medication for well-controlled asthma patients.
Area of Science:
- Pulmonology
- Immunology
- Pharmacology
Background:
- Biologic therapies have revolutionized severe asthma management, offering significant benefits.
- Current guidelines adequately describe biologic initiation ('step-up') but lack clarity on de-escalation ('step-down').
Purpose of the Study:
- To review evidence supporting biologic therapy step-down in severe asthma.
- To discuss tools for assessing biologic efficacy and remission.
- To propose a framework for stepping down asthma therapies.
Main Methods:
- Review of recent practice-changing evidence.
- Discussion of clinical assessment tools for biologic response.
- Proposal of a therapeutic step-down framework.
Main Results:
- Clinical tools are available to assess biologic response and identify patients for potential therapy reduction.
- Some patients achieve clinical remission, allowing for safe tapering or withdrawal of add-on therapies.
- Evidence supports the potential for stepping down therapies in responders and remitters.
Conclusions:
- While consensus is limited, growing evidence supports stepping down biologic therapies in severe asthma for patients in remission.
- Structured guidance is needed to assist clinicians in managing therapy de-escalation for well-controlled asthma.
- Further research is required to refine step-down strategies and address clinical uncertainties.
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