Choosing and switching biological agents in severe asthma.

Abstract

may also benefit from switching to a biologic that targets a different pathway. 6 Another common reason that has been linked to suboptimal response is nonad-herence to baseline controller and/or biologic therapy especially in patients who self-administer their medications at home. In such cases, these issues should be addressed without switching the biologic. 6 Reassessment of asthma biomarker and asthma phenotype are crucial in patients who have no response to initial therapy. Patients with no evidence of airway inflammation and those with neutrophil-predominant disease may benefit from stopping the current biologic and consideration of anti-TSLP, macrolide therapy or bronchial thermoplasty. 1,2,4,6 In summary, in the absence of head-to-head clinical trial comparing different biologic therapies, initial and subsequent biologic choice usually relies on factors such as asthma phenotype, biomarker profile and need for OCS use. All available biologics have shown efficacy in asthma with eosinophilic phenotype. Anti-TSLP is the only approved biologic for non-T2 severe asthma. Before switching to a different biologic, it is imperative first to address adherence to existing therapy, asthma triggers and comorbidities. Reassessment of asthma phenotype and revisiting biomarker profile should guide the next steps in choosing an alternative biologic.