Real world using dual biological therapy in severe asthma: Insights from four cases

To describe the clinical outcomes of patients with severe uncontrolled asthma who received dual biologic therapy after showing only partial improvement with a single biologic agent.

We conducted a descriptive case series of four patients with severe asthma who remained inadequately controlled on biologic monotherapy. A second biologic targeting a different inflammatory pathway was added based on persistent symptoms and biomarker profiles. Clinical outcomes including Asthma Control Test (ACT) scores, asthma exacerbation frequency, oral corticosteroid (OCS) use, and lung function (FEV₁) were evaluated over 12 months of follow-up.

Following dual biologic therapy, all the patients showed significant improvement in Asthma Control Test (ACT) scores, reduction in exacerbations (from a median of 9 to 0.5/year), and reduced oral corticosteroid (OCS) usage (median 9 to 0.5/year). FEV1 remained stable or improved. No significant adverse effects were noted during 12 months of follow-up.

This series highlights that dual biologic therapy is effective and safe in a carefully selected difficult subgroup of severe uncontrolled asthma.