Biologic Medications for Severe Asthma: Implications for Understanding Pathogenic Heterogeneity and Endotypes

Annu Rev Med. 2025 Jan;76(1):339-355. doi: 10.1146/annurev-med-070323-103158. Epub 2025 Jan 16.

Abstract

Asthma is a chronic inflammatory disease of the airways long known for phenotypic heterogeneity. Phenotyping studies in asthma have led to a better characterization of disease pathogenesis, yet further work is needed to pair available treatments with disease endotypes. In this review, the biology of targeted pathways is discussed along with the efficacy of biologic therapies targeting those pathways. Results of asthma clinical trials are included, as well as results of trials in related diseases. This review then analyzes how biologics help to inform the complex immunobiology of asthma and further guide their use while identifying areas for future research.

Keywords: biologic therapy; cytokines; endotypes; eosinophils; molecular phenotypes; severe asthma.

Publication types

  • Review

MeSH terms

  • Anti-Asthmatic Agents* / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Asthma* / drug therapy
  • Asthma* / immunology
  • Biological Products* / therapeutic use
  • Humans
  • Phenotype
  • Severity of Illness Index

Substances

  • Anti-Asthmatic Agents
  • Biological Products
  • Antibodies, Monoclonal, Humanized