New Insight on Biologic Initiation Patterns for Treating Severe Asthma

Biologic therapies offer the potential to significantly reduce the number of exacerbations in patients with severe asthma, and starting them earlier in the disease course could yield substantial benefits for patients and payers, according to research presented at the European Respiratory Society (ERS) Congress 2025. Both posters analyzed the impact of biologics for severe asthma from the UK perspective.

In one abstract, investigators modeled the theoretical impact of earlier biologic initiation for patients with severe asthma, informed using published data and expert input.¹ Age 50 was considered the typical age to start a biologic, but the researchers modeled a population of 54,121 patients in the UK who could be eligible to begin biologic therapy sooner based on clinical criteria including number of exacerbations and cumulative corticosteroid dose. They then estimated the effects on clinical and economic outcomes from starting biologic treatment 5, 10, 15, and 20 years earlier than the current practice.

Their analyses showed that treating patients with biologics 5 years earlier could avert 2000 deaths from both exacerbations and oral corticosteroid–related adverse events. When treating patients 20 years earlier, the number of deaths avoided increased to 3100. Treating patients 5 years earlier reduced the estimated numbers of general practitioner visits by 136,812, emergency department visits by 17,077, and hospitalizations by 29,144; these numbers were 575,771, 71,873, and 122,675, respectively, for starting biologics 20 years earlier.

Extrapolating the benefits of biologics to improvements in productivity via a 50% reduction in exacerbations yielded cohort savings of £2.05 billion across the cohort, or £37,645 per person. Starting biologics 20 years earlier than current practice was also associated with a gain of 73,319 quality-adjusted life-years and more than £3 billion in savings to the health care system.

“The evidence shows that even initiating 5 years earlier than current practice has tangible benefits across all examined outcomes,” the authors wrote. “The findings can be used to inform new models of care for severe asthma patients, which lead to better clinical outcomes and reduce HCRU [health care resource utilization].”

Another abstract examined the effects of biologic use for severe asthma, this time in a real-world population of patients treated in Bradford, a city in the United Kingdom’s West Yorkshire county.² Bradford’s diverse makeup—22% of its inhabitants are South Asian, particularly of Pakistani background—presented a unique opportunity to analyze biologic treatment patterns and outcomes by ethnicity.

Of 140 patients with severe asthma who received biologics at the authors’ institution, 79 (56%) were White and 61 (44%) were Asian or Asian British. Their mean duration of treatment was 4 years and 5 months. The mean age of biologic therapy initiation differed significantly between the ethnic groups, at 49 years in White patients vs 40 years in Asian patients.

Both ethnic groups saw reductions in exacerbations in the year after starting biologic treatment, but the decrease was larger for White patients (65%; from a mean of 6 before to 2 after) than for Asian patients (58%; from 7 to 3). When examining changes in exacerbations by specific biologic, the investigators found greater reductions in White patients than Asian patients receiving mepolizumab or benralizumab, but a larger reduction for Asian patients than White patients taking omalizumab.

The researchers also looked at clinical markers and found no significant posttreatment difference in exhaled nitric oxide or forced expiratory volume in 1 second in either ethnic group. However, both White and Asian patients saw a significant reduction in their eosinophil count after biologic treatment; eosinophil counts decreased by 80% in White patients and 66% in Asian patients.

“This adds to the evidence base of real-life use of biologics in a diverse asthmatic population,” the authors wrote. “It suggests that South Asian patients on average have a higher frequency of annual exacerbations prior to commencing biologic therapy and have an overall poorer response to biologic treatment than White patients.”

References

1. Couillard S, Lugogo N, Winders T, et al. Modelling the impact of earlier biologic initiation in severe asthma patients. Poster presented at: ERS Congress 2025; September 27-October 1; Amsterdam, Netherlands.

2. Bennett E, Henning A, Regan K, et al. The use of biologics in severe asthma in a diverse population: the Bradford experience. Poster presented at: ERS Congress 2025; September 27-October 1; Amsterdam, Netherlands.