Do biologics improve health outcomes in children with severe asthma? – a Cohort study

Extract Asthma is a common chronic lung disease in children, and those with severe asthma suffer from poor symptom control despite treatment plan adherence [1]. Severe asthma is a heterogenous disease associated with different inflammatory phenotypes, and the most common phenotype is characterized by increased T-helper 2 (TH-2) cytokines and mediators [1–3]. Release of these biomarkers leads to increased airflow obstruction, airway hyperresponsiveness, mucus production and remodeling responses, leading to increased symptoms, exacerbations, school absenteeism and decreased quality of life [4, 5]. Although the incidence of severe pediatric asthma is low, the consequences of uncontrolled, severe asthma have significant personal, financial and societal impacts [2, 4]. Therefore, children with uncontrolled severe asthma despite optimized treatments can consider monoclonal antibody (mAb) therapies (“biologics”) [1, 5, 6]. Asthma biologics target biomarkers in the TH-2 inflammatory cascade pathway to suppress asthma pathogenesis [2, 4]. Currently, there are four biologics approved for children (6–18 years) in Canada: omalizumab, mepolizumab, tezepelumab and dupilumab. Each biologic targets a specific inflammatory marker, and health outcomes depend on patients’ underlying level of these different markers [2, 3].