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Review
. 2025 Sep:90:102375.
doi: 10.1016/j.pupt.2025.102375. Epub 2025 Jun 19.

The era of multiple biologics: Is combination and switching an option in the management of severe asthma?

Emmanuel Oshiogwe Okwuofu  1 , Audrey Chee Hui Yong  2 , Jonathan Chee Woei Lim  1 , Johnson Stanslas  3
Affiliations
Review

The era of multiple biologics: Is combination and switching an option in the management of severe asthma?

Emmanuel Oshiogwe Okwuofu et al. Pulm Pharmacol Ther. 2025 Sep.

Abstract

Background and objective: The introduction of biologics therapies targeting specific cytokines relevant to asthma pathophysiology has changed the landscape in the treatment of severe asthma in both adults and children. However, the availability of multiple agents, inclusion criteria for randomised control trials (RCTs), variation in national and international guidelines, instances of treatment failures, and the potential of switching or combining biologic therapies, highlight the need for real-world evidence. Data from real-world studies of biologics in severe asthma may complement efficacy data obtained from RCTs and provide important post-marketing safety information. Additionally, these studies may help inform the design of future clinical trials, characterise the natural history of the disease, and support important translational research. This review highlights current evidence for the combination and switching of biologics in severe asthma and comorbid diseases that may serve as pointers for optimal clinical outcomes.

Method: Pubmed, Scopus, and Web of Science were searched using specified search strategies.

Results: Available evidence suggests that patients with severe asthma who received combination or switched biologics (omalizumab, benralizumab, reslizumab, mepolizumab, dupilumab, and Tezepelumab) in real-world settings experienced significant improvement in asthma control, exacerbation, and lung function. Although combining biologics is not currently a common practice, there are cases where biologic therapies were combined, discontinued, or switched.

Conclusion: Patients may benefit from the early and systematic consideration of combination and switching of biologic therapies in severe asthma.

Keywords: Biologics; Combination; Real-world evidence; Severe asthma; Switching.

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Conflict of interest statement

Declaration of competing interest Please be informed that there are no known conflicts of interest associated with this manuscript and there has been no significant financial support for this work that could have influenced its outcome. All authors included in this publication have contributed significantly. The manuscript has been read and approved by all named authors. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We understand that the Corresponding Author is the sole contact for the Editorial process. He is responsible for communicating with the other authors about progress, submissions of revisions, and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author. Acknowledgements This work was funded by Herbal Research Grant Scheme (HRGS), provided by the Ministry of Agriculture and Agro-Based Industry, Malaysia (HRGS/ NH1015S017).

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