Efficacy of Biologics in the Management of Pediatric Asthma: A Single-Center Retrospective Study

Background Biologics are monoclonal antibodies that target immune mediators of allergic asthma. Their use in children is not as well studied as in adults, and many indications are extrapolated from data conducted with adults. This study aims to evaluate the efficacy of biologics in improving respiratory function and reducing asthma-related morbidities in children and adolescents in a single health system, to compare efficacy between different biologics, and to explore whether differences in baseline biomarkers correlate with differing outcomes. Methods With IRB approval, a retrospective chart review study was conducted on patients with a diagnosis of asthma initiated on a biologic between 2019 and 2023. Indicators of morbidity (asthma severity, number of steroid courses, emergency room visits, hospitalizations), pulmonary function, and biomarker levels (IgE, eosinophils) were assessed for a year before and after biologic initiation. Outcomes pre- and post-biologic initiation were compared using dependent sample t-testing, conducted using IBM SPSS Statistics for Windows, Version 29 (Released 2023; IBM Corp., Armonk, New York, United States). Results One hundred and seventy-six subjects were included in our study. Biologics overall reduced morbidity and improved pulmonary function in children. Morbidity was decreased specifically with omalizumab and dupilumab, while pulmonary function also improved with dupilumab. Mepolizumab, benralizumab, and tezepelumab had small sample sizes, which limited the power of results from their groups. No significant differences in outcomes were noted between groups with different baseline biomarker levels. Conclusions We find that initiation of biologics in children and adolescents with poorly controlled asthma is associated with improvements in terms of morbidity and pulmonary function. Further data is needed on agents less commonly prescribed and for individual agents based on biomarker levels to better understand what role these agents have in managing pediatric asthma and help guide their continued use.