Overview of Biologics Targeting Type 2 Inflammation in Respiratory Disease

The development, introduction, and widespread use of type 2-targeting biologics for respiratory disease has been of dramatic and unprecedented benefit to patients, improving disease control, reducing morbidity, and allowing for avoidance of more toxic therapies such as reliance on chronic systemic corticosteroids. Developed to treat more severe forms of asthma, the available biologics-benralizumab, dupilumab, mepolizumab, omalizumab, reslizumab, and tezepelumab-have been successfully applied to treat other diseases of the upper and lower airways. Indeed, multiple different biologics are now approved by the Food and Drug Administration for each general clinical indication: severe asthma, chronic obstructive pulmonary disease, eosinophilic granulomatosis with polyangiitis, and chronic rhinosinusitis with nasal polyposis. Clinically, the selection of a type 2-targeting biologic for respiratory disease starts with the confirmation of a specific diagnosis, assessment of responsiveness to previous medical (and surgical) therapies, and determination whether underlying type 2 inflammation is present. Other critical considerations include route of administration, accessibility, insurance coverage, and patient preference. In some cases, there may be only 1 biologic available for a patient. However, as often is the case, patients may indeed qualify for, or potentially benefit from, more than 1 treatment. Selecting the right treatment-that which is most effective-can be a challenge. In this review, we provide practical and evidence-based recommendations about selecting a type 2 biologic across the spectrum of respiratory diseases.