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The use of biologic therapies in pediatric severe asthma
Cristiana Indolfi1, Angela Klain1, Michele Miraglia Del Giudice1
1Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Napoli, Italy.
Insights
Biological therapies offer targeted treatments for severe pediatric asthma, improving quality of life. This review covers approved biologics, emerging agents, and future research directions for better asthma management.
Area of Science:
- Pediatric Pulmonology
- Immunology
- Pharmacology
Background:
- Severe asthma in children is a complex, chronic condition impacting daily life.
- Traditional treatments face limitations in managing heterogeneous pediatric asthma phenotypes.
- Biological therapies have emerged as a transformative approach for targeted interventions.
Purpose of the Study:
- To review current evidence on approved biologic therapies for pediatric severe asthma.
- To discuss mechanisms of action, clinical trial data, and real-world evidence.
- To explore emerging biologics and the concept of asthma remission in children.
Main Methods:
- Comprehensive literature search of PubMed, Embase, and conference proceedings up to May 2025.
- Analysis of pivotal clinical trials and real-world data for approved biologics.
- Examination of emerging agents targeting upstream inflammatory pathways.
Main Results:
- Omalizumab, mepolizumab, benralizumab, and dupilumab are approved biologics with demonstrated efficacy.
- Emerging agents like tezepelumab and anti-IL-33 therapies show promise.
- Data on long-term outcomes and the potential for asthma remission are being investigated.
Conclusions:
- Biologics represent a significant advancement in personalized pediatric asthma management.
- Optimizing patient selection, access, and understanding long-term effects remain key challenges.
- Future research should focus on early intervention, cost-effectiveness, and disease modification.
Introduction:
Severe asthma in children is a chronic, heterogeneous condition that significantly impacts quality of life and poses management challenges. The introduction of biological therapies has transformed treatment paradigms, offering targeted interventions for patients with specific phenotypes.
Areas Covered:
This review provides an overview of the current evidence on biologic therapies approved for pediatric severe asthma, including omalizumab, mepolizumab, benralizumab, and dupilumab. We discuss their mechanisms of action, pivotal clinical trials, real-world data, and practical considerations for use. A comprehensive literature search was performed using PubMed, Embase, and major conference proceedings up to May 2025. We also examine emerging biologic agents targeting upstream pathways, such as tezepelumab and anti-IL-33 therapies, and explore the concept of asthma remission and its implications for long-term disease trajectories.
Expert Opinion:
Biologics represent a significant advancement in pediatric asthma management, enabling for tailored treatments based on underlying pathophysiology. However, challenges persist in optimizing patient selection, enhancing access, and comprehending long-term outcomes. Future research should focus on early intervention strategies, cost-effectiveness analyses, and the potential for disease-modifying effects in children.
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