Emerging pharmacotherapeutic options for adult asthma

INTRODUCTION: Current biologics have transformed asthma management, however incomplete responses in some patients with type 2-high disease, and the absence of approved targeted therapies for type 2-low asthma, highlights the need for novel treatment strategies summarized in this review. AREAS COVERED: This review examines literature gathered from searches of PubMed, clinicaltrials.gov and conference abstracts from 2014 to present for listings of approved biologics and investigational therapies across the severe asthma treatment landscape. This review includes clinical trials, preclinical studies, and guideline recommendations to evaluate established and emerging approaches, including next-generation anti-IgE, anti-IL-5/IL-5 R, anti-IL-4/IL-13, and anti-TSLP therapies, together with novel targets that are in early-stage clinical trials such as IL-33/ST2, mast cell pathways, and transcription factor inhibitors. EXPERT OPINION: There is a shift from single-cytokine blockade toward broader modulation of airway inflammation through multi-specific antibodies and intracellular signalling targets. Major unmet needs remain in type 2-low asthma, where no biologic is is specifically approved for this endotype. Future progress will depend on improved biomarker-guided patient stratification and the development of therapies capable of achieving individualized, mechanism-driven disease modification.