How to choose a biologic agent considering comorbidities of bronchial asthma

Biologic therapies have revolutionized the treatment of severe asthma. However, the selection of the optimal biologic agent remains challenging because of the heterogeneity of disease phenotypes and frequent comorbidities. This mini-review explored the clinical relevance of comorbidities in the selection of biologics for patients with asthma. Herein, we summarize recent evidence on the prevalence of comorbidities associated with type 2 inflammation, including chronic spontaneous urticaria, atopic dermatitis, prurigo nodularis, chronic rhinosinusitis with nasal polyps, eosinophilic granulomatosis with polyangiitis, eosinophilic otitis media, aspirin-exacerbated respiratory disease, allergic rhinitis, allergic bronchopulmonary mycosis, obesity, and chronic obstructive pulmonary disease, and review the efficacy of five major biologics (omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab) in these settings. Each biologic targets distinct immunologic pathways in type 2 inflammation, including IgE, IL-5, IL-5Rα, IL-4Rα, and thymic stromal lymphopoietin, respectively. In conclusion, the assessment of comorbidities in addition to biomarkers is essential for tailoring biologic therapies for severe asthma. Integrating comorbidity profiles into treatment strategies allows for a more precise and effective use of biologics, ultimately improving outcomes in complicated asthma cases.