Respiratory Biologics Linked to Reduced Asthma Exacerbations Across Patient Groups

Respiratory biologics were associated with reductions in asthma exacerbations in patients with varying asthma severity, aligning with prior evidence of their potential to improve patient outcomes.

These findings, newly published in JAMA Network Open, address the emergence of monoclonal antibodies (biologics) over the past 2 decades and the impact they’ve had on asthma-related morbidity and mortality. The treatment poses another option for patients with asthma as opposed to the use of corticosteroids, which have been associated with a significant risk of adverse events related to cardiovascular, metabolic, gastrointestinal, and skeletal effects, although not limited to these.² The present study aimed to evaluate population trends regarding asthma exacerbations, paying special attention to periods of multiple biologic approvals.

The study focused on exacerbation trends specifically around 2015, which investigators coined as the “biologic boom.” This time period is important because numerous biologics were approved during and after that particular year. Most importantly, 2015 was when the second widely available asthma biologic, mepolizumab (Nucala; GSK), was approved. Mepolizumab addressed a significant gap in asthma biologic approvals at that time, given that the first and only available asthma biologic until then was omalizumab (Xolair; Genentech), approved in 2003.¹

The study used data from electronic health records of patients 18 and older diagnosed with asthma between January 1, 2006, and May 31, 2025, in an integrated health care system in Boston, Massachusetts. Individuals with other chronic health diseases like interstitial lung disease, cystic fibrosis, bronchiectasis, and chronic obstructive pulmonary disease (COPD) were excluded from the analysis.

The primary outcome was change in the intercept and slope of annual exacerbations per 1000 patients with asthma per year. Of the 5269 patients included in the study, the mean age was 51.9 years, and 71.4% were female. Among participants, 2.7% identified as Asian, 9.2% as Black, and 2.9% as Hispanic.

Asthma Exacerbations Declined Following the Introduction of Respiratory Biologics

Prior to 2015, researchers observed an upward trend in annual exacerbations (155.4 [95% CI, 117.7-193.2] exacerbation events per 1000 patients per year) that fell sharply after 2015 (–474.1 [95% CI, –783.2 to –165.0] exacerbation events per 1000 patients per year) and a sustained improvement over time (–206.5 [95% CI, –259.9 to –153.0] exacerbation events per 1000 patients per year) in the postexposure period.

When assessed by various subgroups, all age groups and both sexes experienced sustained reductions in annual exacerbation events following 2015. Patients, regardless of insurance, experienced similar trends as the age and sex subgroup.

Patients with a body mass index (BMI) of 30 or greater experienced slightly more exacerbations compared with patients whose BMI was less than 30 in the pre-exposure period. Yet, following 2015, they experienced a decrease in exacerbation similar to the previously stated subgroups.

Patients who experienced 2 or more baseline exacerbations exhibited similar trends of progressive increase in exacerbations before 2015 (190.9 [95% CI, 88.5-293.3] exacerbation events per 1000 patients per year) and a reduction following, although it was not statistically significant (–808.2 [95% CI, –1646.5 to 30.2] exacerbation events per 1000 patients per year). The overall subgroup exhibited sustained reductions over time (–374.5 [95% CI, –519.4 to –229.7] exacerbation events per 1000 patients per year).

Patients with blood eosinophil counts of 450 cells/μL or greater, those who used other maintenance therapies, and those without concomitant COPD all experienced similar trends in decreased exacerbations following 2015 and sustained reductions over time.

Study Supports Population-Level Benefits of Asthma Biologics Despite Limitations

“After adjusting for potential confounding factors, the estimated reduction in exacerbations post 2015 was even larger, suggesting that the introduction of biologics was associated with greater reductions in exacerbations than indicated by the unadjusted analysis,” the study authors wrote.

The study was limited by its observational design, and therefore, causal inference cannot be definitively established. There was also the potential for disease misclassification using administrative coding, thus limiting generalizability.

“These findings highlighted the effectiveness of biologics in reducing asthma morbidity and their potential to reduce disparities in asthma-related outcomes,” the study authors concluded.

References

1. Tu YF, Stein DW, Akenroye A. Population-level trends in asthma exacerbations after introduction of respiratory biologics. JAMA Netw Open. 2026;9(6):e2620272. doi:10.1001/jamanetworkopen.2026.20272

2. McCrear S. SUNRISE trial: Tezepelumab reduces steroid use in severe asthma. AJMC^®. June 5, 2026. Accessed June 23, 2026. https://www.ajmc.com/view/sunrise-trial-tezepelumab-reduces-steroid-use-in-severe-asthma