Comparative effectiveness of approved biologics in treating moderate-to-severe allergic asthma: a systematic review and network meta-analysis

Objective: The aim of this study was to conduct a network meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of various biologics for treating moderate-to-severe allergic asthma. Methods: This study conducted a comprehensive and systematic literature search in Cochrane Library, Embase, PubMed, and Web of Science databases, from the inception to December 31, 2024.The data extracted from eligible literature were analyzed using the Cochrane Randomized Trials Risk of Bias 2 tool and Stata 18.0 program. Results: A total of 19 RCTs, involving 7,449 patients with moderate-to-severe allergic asthma, were included in this network meta-analysis. In terms of reducing exacerbations, benralizumab (mean difference(MD) = -0.47, 95% confidence interval (CI )[-0.82, -0.12]), dupilumab (MD = -0.47, 95% CI[-0.72, -0.21]), omalizumab (MD = -0.30, 95% CI [-0.42, -0.17]), and tezepelumab (MD = -0.81, 95% CI [-1.09, -0.54]) all demonstrated superior efficacy compared to placebo. Additionally, tezepelumab was markedly more advanced than omalizumab (MD = -0.52, 95% CI [-0.80, -0.23]). With regard to lung function improvement, dupilumab (MD=0.16, 95% CI [0.07, 0.24]) and tezepelumab (MD=0.08, 95% CI [0.03, 0.14]) both exceeded placebo. Regarding asthma control, dupilumab (MD=-0.40, 95% CI [-0.77, -0.04]) and omalizumab (MD=-0.49, 95% CI [-0.89, -0.08]) both effectively lowered scores on the asthma control questionnaire (ACQ) compared to placebo. For enhancing quality of life, omalizumab (MD=0.62, 95% CI[0.21, 1.03]) significantly raised scores on the standardized asthma quality of life questionnaire (AQLQ[S]+12) relative to placebo. Conclusion: Considering its significant clinical advantages in reducing exacerbations and improving lung function, tezepelumab should be prioritized as a treatment option for moderate-to-severe allergic asthma.