Real-World Data Reveal Biologic Switching Patterns in Severe Asthma Management
A retrospective analysis of real-world clinical data from a large U.S. network of allergy and asthma specialty clinics revealed that while most patients remained on their initial biologic therapy, a substantial minority switched, often due to inadequate clinical response.
Investigators presented these findings at the American College of Allergy, Asthma & Immunology 2025 Annual Scientific Meeting.
The study included patients with severe asthma, identified using ICD-10 codes and biologic prescription records. Among those treated with biologics, the highest persistence was observed for tezepelumab (92%), dupilumab (90%), and omalizumab (85%).
Switching between biologics occurred most frequently from benralizumab to dupilumab (44% of benralizumab switchers) and from omalizumab to dupilumab (38%). The predominant reason for switching across all biologics was lack of efficacy, cited in over half of cases. Specifically, 72% of switches from benralizumab to tezepelumab and 75% from omalizumab to tezepelumab were attributed to inadequate response.
“Lack of efficacy was the most common reason for switching across all agents,” the authors wrote, emphasizing the need for continuous clinical assessment and personalized treatment approaches. Other documented reasons for switching included adverse effects, payer restrictions, and disease progression.
Notably, side effects were a more frequent driver of switches from dupilumab (28%) compared to omalizumab (7%). These findings suggest variation in tolerability among agents and further highlight the need for individualized care.
“In this real-world specialty setting, most patients remained on their initial biologic; however, many switched, often due to perceived lack of efficacy,” the study concluded. The authors stressed the importance of shared decision-making and close monitoring to optimize long-term disease control in severe asthma.
Reference
Switching biologics in severe asthma: real-world insights and clinical rationale. Presented at: American College of Allergy, Asthma & Immunology 2025 Annual Scientific Meeting; November 6-10, 2025; Orlando, FL.
