A large-scale study finds that the introduction of asthma biologics in 2015 has led to immediate and sustained reductions in exacerbations at the population level.
RT’s Three Key Takeaways:
- Population-Level Impact: The study found that the introduction of multiple respiratory biologics since 2015 is associated with immediate and sustained declines in asthma exacerbation rates among adults.
- Severe Disease Benefits: Patients with more severe asthma and those with elevated eosinophil counts of 450 cells/μL or higher experienced the most significant reductions in exacerbations following the approval of these therapies.
- Narrowing Outcome Gaps: The use of biologics has helped close the performance gap between patients with moderate-to-severe asthma and those with milder forms of the disease who do not typically qualify for such treatments.
The introduction of respiratory biologics has been associated with significant reductions in asthma exacerbations at the population level, according to a large cohort study published in JAMA Network Open.
Researchers found that adults with asthma experienced both immediate and sustained declines in exacerbation rates following the approval of multiple biologic therapies. The most significant improvements were observed among patients with more severe forms of the disease.
To investigate the impact of these treatments, researchers analyzed electronic health record data from 5,269 adults with physician-diagnosed asthma treated at specialty allergy and pulmonology clinics within a large healthcare system in Boston between 2006 and 2025.
The investigators selected 2015 as a key time point because it marked the beginning of a period of rapid regulatory approval for respiratory biologics. Four of the six currently available therapies received approval from the USFDA between 2015 and 2018.
Using an interrupted time series analysis, the study examined changes in annual asthma exacerbation rates before and after the introduction of these treatments. Between 2006 and 2015, asthma exacerbations were increasing steadily among the study population. Following 2015, however, researchers observed a significant immediate reduction in exacerbation rates, which was followed by sustained yearly declines throughout the study period.
The most pronounced improvements were seen in patients with more severe asthma. Individuals who experienced two or more exacerbations annually demonstrated larger reductions than patients with fewer exacerbations.
Similarly, patients with elevated eosinophil counts—an important biomarker of type 2 inflammation—experienced some of the greatest improvements after biologics became available. Those with eosinophil levels of 450 cells/μL or higher showed substantially larger reductions in exacerbation rates than patients with lower eosinophil counts.
The reduction in asthma exacerbations was observed across a wide range of demographic and clinical subgroups, including differences in age, sex, smoking status, body mass index, and insurance status. Although smokers and individuals living in inner-city areas continued to experience higher overall exacerbation rates, these groups also benefited from the downward trends observed following the introduction of biologic therapies.
The authors noted that patients with moderate-to-severe asthma experienced improvements that helped narrow the gap in outcomes traditionally seen between them and patients with mild asthma, who are generally not eligible for biologic treatment.
The researchers concluded that respiratory biologics have been associated with meaningful improvements in asthma outcomes at a population level. While observational studies cannot establish causality, the timing and consistency of the observed reductions support the role these therapies may play in managing severe asthma.
The findings add to growing evidence that biologics not only improve outcomes in clinical trials but may also deliver benefits when implemented in routine clinical practice, particularly among patients at highest risk of asthma exacerbations, the study authors said in the report.
Reference
Tu Y et al . Population-Level Trends in Asthma Exacerbations After Introduction of Respiratory Biologics. JAMA Netw Open. 2026;9(6):e2620272.
This article was originally published by AMJ and was made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
