How to Adjust Asthma Management Once Asthma Is Controlled on Long-Term Biologic Therapy

Monoclonal antibodies that target IgE, IL-5, the IL-5 receptor, IL-4 receptor α, or thymic stromal lymphopoietin have improved outcomes, reduced exacerbations, minimized symptoms, improved lung function, and facilitated corticosteroid withdrawal. Although it is possible to achieve remission with these biologics, many patients inquire about the feasibility of discontinuing the biologic or inhalers, or considering alternative dosing strategies. In this commentary, we review available data regarding the safety and efficacy of different asthma medication management options once asthma is controlled with long-term biologic therapy. We evaluate stopping biologics while continuing inhaler therapy, stopping background therapy while continuing biologics, reducing the biologic dose, increasing the biologic interval, and other strategies including seasonal administration of biologics. It is clear that many patients can safely adopt some of these approaches that will make their lives easier and result in potentially less expensive for patient and payers. More research is needed to tell us who, when, and how to adopt these alternative regimens.