Biologic Therapies in Severe Asthma and Eosinophilic Granulomatosis with Polyangiitis - Targeted Therapy and Personalized Care

Sep 30, 2026

Uploaded by Mabel

Biologic agents have revolutionized severe asthma management by enabling biomarker-driven care. Five monoclonal antibodies—omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab—are widely used, while newly approved tezepelumab extends treatment options for T2-low phenotypes. Despite improved access, clinicians often face uncertainty when choosing the most suitable initial biologic. This review presents real-world cases to illustrate phenotype-guided selection for asthma and EGPA and evaluates advances aimed at improving accessibility and clinical efficacy through integration of emerging evidence with patient-specific factors.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

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Abstract

Introduction

Case 1

Considerations before using a biologic

Table 1. Suggested checklist before using biologics in severe asthma

Review Biologic Therapies in Severe Asthma and Eosinophilic Granulomatosis with Polyangiitis: Targeted Therapy and Personalized Care Sang Hyuk Kim Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea [https://doi.org/10.4046/trd.2025.0131](https://doi.org/10.4046/trd.2025.0131) ISSN: 1738-3536(Print)/ 2005-6184(Online) Tuberc Respir Dis 2026;89:1-9 Copyright © 2026 The Korean Academy of Tuberculosis and Respiratory Diseases Biologic candidate T2-low T2-high |
T | |
O M R B D T | | --- | --- | --- | Allergic Eosinophilic |
O | | M R B
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D |
T | | --- | --- | --- | --- | --- | O Omalizumab M Mepolizumab R Reslizumab B Benralizumab D Dupilumab T Tezepelumab AHR Lung function CRSwNP COPD High FeNO Exacerbations EGPA OCS-dependent Abstract Biologic agents have revolutionized severe asthma management by supporting biomarker-driven approaches. Five monoclonal antibodies—omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab—are in widespread use, while the recently approved tezepelumab, an anti-thymic stromal lymphopoietin, broadens therapeutic possibilities to encompass the type 2 inflammation‑low phenotype. Although biologics have become more accessible, clinicians frequently encounter difficulties in choosing the most appropriate initial biologic therapy. This review describes real-world cases that demonstrate phenotype-guided selection of biologics for individuals with asthma or eosinophilic granulomatosis with polyangiitis. Additionally, current advances in biologic therapies are examined regarding their capacity to improve both accessibility and clinical efficacy. Moving forward, the integration of emerging evidence with patient‑specific factors could further promote disease modification in the management of severe asthma. Keywords: Asthma; Severe Asthma; Biologics; Personalized Care Address for correspondence Sang Hyuk Kim Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea Phone 82-2-2626-3192 Fax 82-2-2626-1166 [E-mail](E-mail gost702@korea.ac.kr)[ gost702@korea.ac.kr](E-mail gost702@korea.ac.kr)[ ](E-mail gost702@korea.ac.kr)[Received](Received Aug. 1)[ Aug. 1](Received Aug. 1), 2025 Revised Sep. 23, 2025 Accepted Oct. 13, 2025 Published online Oct. 15, 2025 It is identical to the Creative Commons Attribution NonCommercial License ([http://](http://)[ ](http://)[creativecommons.org/licenses/](creativecommons.org/licenses/)[ ](creativecommons.org/licenses/)[by-nc/4.0/](by-nc/4.0/)) . Tuberc Respir Dis 2026;89:1-9 [https://e-trd.org/](https://e-trd.org/ 1)[ 1](https://e-trd.org/ 1) SH Kim Introduction Severe asthma poses a significant challenge in asthma management, impacting more than 10 million individuals worldwide1. In recent years, biologic therapies have significantly changed the therapeutic landscape for severe asthma2,3 . Clinicians are now able to tailor treatments based on biomarkers, including immunoglobulin E (IgE), blood eosinophil levels, and fractional exhaled nitric oxide (FeNO), which indicate type 2 inflammation (T2) activation4. Until a few years ago, five monoclonal antibodies—omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab—had received global approval for the management of severe asthma5. More recently, a sixth biologic agent, tezepelumab—an anti-thymic stromal lymphopoietin (TSLP) antibody—has expanded therapeutic options to include patients with T2-low severe asthma6. Nonetheless, there are still considerable unmet needs, such as achieving true disease modification, improving control of oral corticosteroid (OCS)-dependent asthma, and developing effective approaches for indiv

FAQs

Which biologic agents are commonly used for severe asthma mentioned in the review?

The review lists omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab as widely used monoclonal antibodies for severe asthma.

What new therapeutic option does tezepelumab provide according to the text?

Tezepelumab is described as an anti-TSLP antibody that expands treatment to include patients with T2-low severe asthma phenotypes.

What factors should clinicians assess before using a biologic in severe asthma?

The review emphasizes careful assessment of factors such as confirmed asthma diagnosis and objective evidence of variable airflow limitation, as well as loss of asthma control and optimization of triggers, supported by a checklist in Table 1.

Sep 30, 2026

Uploaded by Mabel