Biologic therapies for severe asthma with type 2 inflammation: current evidence, patient selection, and future perspectives.

OBJECTIVE

Recent advancements in biologic therapies have revolutionized the treatment landscape for allergic asthma by improving patient outcomes through targeted immune modulation. This review synthesizes contemporary clinical evidence, evaluates criteria for optimal patient selection, examines safety considerations, and highlights future therapeutic directions for managing severe allergic asthma.

METHODS

A systematic literature search was conducted across major medical databases, including PubMed, Embase, and Cochrane, up to 2025. The search prioritized randomized controlled trials, meta-analyses, and real-world studies involving biologic agents targeting immunoglobulin E (IgE) and key type 2 inflammatory pathways. Studies were selected based on relevance to efficacy, safety, and personalized clinical application of agents such as omalizumab, IL-5 antagonists, dupilumab, and tezepelumab, with emphasis on biomarker-guided precision medicine approaches.

RESULTS

Evidence demonstrates that biologic therapies significantly reduce asthma exacerbations, hospital admissions, and reliance on systemic corticosteroids while improving lung function and quality of life. Biomarkers including blood eosinophil counts, serum IgE, and fractional exhaled nitric oxide (FeNO) enhance therapeutic selection and response prediction. Despite substantial clinical benefits, challenges remain regarding accessibility, cost, and long-term safety data. Emerging biologics and combination strategies show promise for further improving outcomes.

CONCLUSIONS

Biologic agents targeting type 2 inflammation represent a paradigm shift in allergic asthma management. Personalized treatment strategies maximize clinical benefits; however, continued research is required to refine patient selection, address healthcare disparities, and expand therapeutic options.