Biologics in nonsevere asthma

Paul M. O’Byrne, MB, is a professor of medicine and dean and vice-president of the Faculty of Health Sciences at McMaster University.

Should we offer biologic therapy to patients with nonsevere asthma?

In my opinion, the use of biologics or drugs that target these proteins, the T2 proteins, interleukin 5 (IL-5), IL-4, IL-13, and thymic stromal lymphopoietin (TSLP), for example, will slowly move into less severe populations. With the anti-TSLP antibody, tezepelumab, we already have very convincing evidence that it can provide useful clinical benefit even in patients with mild asthma.

The fact that restricts their use in populations that are not severe is their cost. They are very expensive and for that reason at the moment are limited only to patients with severe asthma who are at very high risk of having asthma exacerbations or requiring hospitalization because of their asthma. If the cost were lower or if there are new developments that allow approaches that target these proteins without using specific biologics, I think they will be used much more widely in milder disease.