Advanced Biologic Therapies in the Management of Asthma in Children and Adolescents: A Comprehensive Network Meta-Analysis

INTRODUCTION: Emerging evidence has underscored the positive impact of biologics on asthmatic patients. However, there is a pressing need to verify their therapeutic efficacy in children and adolescents with asthma. To address this, we conducted a network meta-analysis (NMA) to evaluate the efficacy and safety of biologics in the asthma management of this demographic. METHODS: The databases of PubMed, Embase, Web of Science, and Cochrane Library were comprehensively searched in our study until May 29, 2024. Only randomized controlled trials were included to estimate the value of biologics on asthmatic children and adolescents. Data extraction and risk of bias assessment were independently performed by two researchers. Outcomes were analyzed by a fixed effects model, and the surface under the cumulative ranking (SUCRA) scores were calculated to determine the likelihood of each biologic being the most effective intervention. RESULTS: 2,672 patients were included for comparing four different biologics (dupilumab, omalizumab, lebrikizumab, and mepolizumab) with a placebo. Dupilumab has been demonstrated to have the highest efficacy in reducing asthmatic exacerbations, improving lung function, and improving patients' quality of life, with the SUCRA values of 0.956, 0.999, and 0.897, respectively. Omalizumab showed the best safety potential by reducing the risk of adverse and severe events, with the SUCRA values of 0.876 and 0.930. CONCLUSIONS: In this NMA, focusing on biologics that target type 2 inflammation in childhood and adolescent asthma, four biologics demonstrated a favorable safety profile. Notably, dupilumab emerged as the most effective, while omalizumab was identified as the safest therapy. Further studies must be conducted in order to confirm these findings.