Stepping down biologics in asthma: is it time to challenge the status quo?

Extract Rapid advances in biologic therapy have truly revolutionised the management of severe asthma in the past decade. The efficacy of these drugs has been undeniably demonstrated in randomised controlled trials (RCTs) and real-world studies, with reassuring safety data. Many patients with severe asthma have had their lives transformed after starting a biologic, which is an extremely gratifying result. Questions remain, however, about the optimal long-term management of patients with severe asthma treated with biologics. The Global Initiative for Asthma (GINA) recommends assessing response to biologic therapy after 4 months of treatment and to consider switching to a different biologic in patients with partial or no clinical response [1, 2]. In patients with good clinical response and controlled asthma, stepwise reduction in background controller therapy is recommended, starting with maintenance oral corticosteroids (OCS).