BIOLOGICAL TREATMENT OF SEVERE ASTHMA: A COMPARATIVE ANALYSIS OF TEZEPELUMAB, MEPOLIZUMAB, BENRALIZUMAB, AND DUPILUMAB

Vollständiger Abstract

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Introduction: Bronchial asthma remains a significant clinical problem despite advances in pharmacological treatment. Approximately 5–10% of asthma patients suffer from a severe, uncontrolled form of the disease associated with frequent exacerbations, impaired lung function, reduced quality of life, and increased hospitalization rates. The introduction of biologic therapies targeting Th2-dependent inflammatory pathways has significantly improved treatment outcomes in this group of patients. Aim of the Study: The aim of this study was to analyze and compare the efficacy and safety of biologic therapies used in the treatment of severe asthma, with particular emphasis on tezepelumab, mepolizumab, benralizumab, and dupilumab, based on clinical trials and real-world studies. Materials and Methods: A literature review was conducted using the PubMed database. Original clinical trials, prospective studies, and real-world observational studies published between 2020 and 2026 were included in the analysis. The effects of biologic therapies on asthma exacerbation reduction, improvement in lung function, reduction in oral corticosteroid use, achievement of clinical remission, and long-term treatment safety were evaluated. Results: All analyzed biologic therapies demonstrated significant clinical efficacy in the treatment of severe asthma. Tezepelumab led to a substantial reduction in the number of exacerbations, improvement in pulmonary function parameters, and reduction in oral corticosteroid use regardless of eosinophil levels. Mepolizumab and benralizumab showed comparable efficacy, particularly in patients with eosinophilic asthma. Dupilumab demonstrated high efficacy in patients with type 2 inflammation, especially regarding improvement in lung function. Real-world studies confirmed the effectiveness and favorable safety profile of biologic therapies observed in randomized clinical trials. Conclusions: Biologic therapies constitute an effective and safe treatment option for severe asthma and significantly improve disease control and patients’ quality of life. The strongest clinical evidence concerns tezepelumab, mepolizumab, benralizumab, and dupilumab; however, treatment efficacy may depend on the disease phenotype and inflammatory biomarkers. Further studies are needed to optimize the personalization of biologic therapies and to standardize remission criteria in severe asthma.