In recent years, the evolution of biologic therapies for severe asthma has paralleled advancements in other chronic conditions such as rheumatoid arthritis and psoriasis, where biologics have also transformed treatment paradigms. One common trend is the increasing focus on identifying biomarkers that predict responses to specific therapies, which has been proven critical for personalising treatment and optimising outcomes. In asthma, as in autoimmune diseases, biologics targeting cytokine pathways such as interleukin (IL)-4, IL-5, and anti-thymic stromal lymphopoietin enable clinicians to tailor treatments to inflammatory subtypes, moving towards a more personalised model of care. This approach is reminiscent of the use of targeted biologic therapies in rheumatoid arthritis, where drugs such as tocilizumab and tumour necrosis factor inhibitors are selected based on inflammation profiles, minimising unnecessary exposure to ineffective treatments (Romão et al, 2017).
The trend towards using biologics as “disease modifiers” as opposed to simple symptom controllers is another noteworthy shift, with roots in oncology and rheumatoid arthritis. In severe asthma, therapies such as tezepelumab and dupilumab show promise for sustained control beyond immediate symptom management. This long-term impact suggests the possibility of achieving disease remission – a concept that has been well-established in rheumatoid arthritis and is now gaining traction in respiratory diseases. Drawing on patterns from these fields, researchers are exploring whether long-term, controlled treatment could lead to a “retraining” of the immune system, reducing the disease’s intensity and recurrence even after discontinuation of the therapy (Pavord, 2024).
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Furthermore, asthma research is beginning to borrow from oncology’s advances in real-world evidence (RWE) and registries, which have proven invaluable in understanding biologic therapies’ effectiveness and safety across broader, more diverse populations. Real-world studies such as those tracking tezepelumab in severe asthma have shown that while clinical trials offer critical efficacy insights, RWE provides a more nuanced understanding of how these therapies perform across age groups, ethnicities, and comorbid conditions, enhancing the rigour of personalised care (Rind et al, 2024). The use of this model is seen extensively in oncology, where RWE complements trial data to refine patient selection and dosing strategies for immunotherapies and targeted agents, emphasising the need for continuous data beyond initial clinical approval. Another insight drawn from trends in dermatology and autoimmune diseases is the emphasis on achieving patient-centred outcomes. In diseases such as psoriasis, biologics have dramatically improved not just clinical measures but also quality of life by reducing skin lesions and flares. Similarly, in asthma, biologics are now evaluated for their impact on lung function and exacerbation rates, as well as their ability to improve daily functioning, reduce hospital visits, and decrease dependency on oral corticosteroids, which have significant side effects. This shift reflects a broader movement in medicine, where patient-reported outcomes are increasingly integrated into treatment evaluations, prioritising the overall life experience of patients (Sardon-Prado et al, 2023).
As biologics continue to evolve, combination therapy models from oncology and infectious disease management are gaining interest. For example, combining biologics with lifestyle or environmental modifications might enhance asthma control for patients with complex or multiple triggers. In other fields such as human immunodeficiency virus treatment, combination therapies have improved disease control and reduced resistance. Similar strategies in asthma could leverage biologics’ strengths alongside optimised lifestyle management, potentially increasing adherence and maximising therapeutic impact.
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