Patterns and Clinical Efficacy of Biologics Switching in Patients With Severe Asthma: A Systematic Review and Meta-Analysis.

2026-04-04
Allergy 81(5)
- Yang Zheng
- Ya-Chun Li
- Sheng-Jie Li
- Meng Xu
- Jia-Qian Hu
- Wen-Qu Tian
- Shi-Wei Chen
- Xue-Hui Li
- Ying He
- Gan Lu
- Mübeccel Akdis
- Ioana Agache
- Cezmi A Akdis
- Ya-Dong Gao

PubMed: 41934326
DOI: 10.1111/all.70333

Study Design

Type: Meta-Analysis
Sample size: n = 1,005
Population: 2292 switched severe asthma patients
Methods: Systematic review following PRISMA guidelines, searches up to September 2025, included studies on biologic switching, calculated SMD, MD, and pooled RR for pre- and post-switch comparisons

Background

This systematic review (SR) aims to delineate the patterns and rationales for biologic switching in patients with severe asthma and evaluate its efficacy across the clinical remission criteria.

Methods

The SR followed the PRISMA guidelines (PROSPERO CRD420251155819), with searches up to September 2025. Studies reporting on switching of biologics, including anti-IgE, anti-IL-4R/13R, anti-IL5/5R, and anti-TSLP, were included. Standardized mean difference (SMD) or mean difference (MD), and pooled relative risk (RR) were calculated for pre- and post- switch comparisons.

Results

The SR included 49 studies (2292 switched severe asthma patients). The most common switching patterns were mepolizumab-benralizumab (n = 637) and omalizumab-mepolizumab/benralizumab (n = 386 or 305, respectively). Additional switching patterns included transitions from other biologicals to dupilumab or tezepelumab. Suboptimal asthma control (n = 1005, 77.0%) was the predominant reason for switching. The switch led to a significant reduction in exacerbations (SMD -1.03, 95% CI: -1.26 to -0.80, I² = 89%), emergency department visits, hospitalizations, and maintenance oral corticosteroid dose and to improved asthma control ACT MD 5.18 (95% CI 4.32 to 6.04, I² = 80%), ACQ MD -1.05 (95% CI -1.26 to -0.83, I² = 45%) and lung function FEV1 MD 0.18 L (95% CI: 0.11 to 0.25, I² = 0%). T2-biomarkers (blood eosinophils, total serum IgE, FeNO) significantly decreased.

Conclusion

Biologics switching represents a promising strategy supported by high-quality evidence of its clinical efficacy. Switching should consider clinical remission goals, co-morbidities, side effects, costs and reimbursement policies, and patient preferences.