The development of monoclonal antibody therapies targeting specific components of the pathways relevant to asthma pathophysiology has revolutionized treatment of severe asthma both in adults and children and helped to further unravel the heterogeneity of this disease. However, the availability of multiple agents, often with overlapping eligibility criteria, creates a need for pragmatic guidance for specialists undertaking care of patients with severe asthma. In this review, we provide an overview of the data supporting the clinical efficacy of biologics in distinct asthma phenotypes/endotypes. We also focus on the role of biomarkers and treatable traits, including comorbidities, in the choice of asthma biologics, highlight which treatments have been demonstrated to be steroid sparing in corticosteroid dependent asthma, and provide practical guidance that can drive shared decision making on treatment choice with patients. In addition, we summarize what is known to date regarding long-term safety of these drugs, and lastly, discuss future directions in biologics research.

Department Clin Pharm and Pharmacol Univ Groningen Univ Med Ctr Groningen Groningen Netherlands; Department of Microbiology Immunology and Transplantation KU Leuven Catholic University of Leuven Belgium; Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic; Department of Respiratory Medicine and Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden

Department of Pediatrics Department of Pulmonology and Phthisiology Department of Allergology and Clinical Immunology Jessenius Faculty of Medicine Comenius University in Bratislava University Teaching Hospital in Martin Martin Slovakia

Department of Respiratory Medicine and Allergology Lund University Lund Sweden

Galenus Health Hasselt Belgium

Mount Sinai National Jewish Health Respiratory Institute Icahn School of Medicine at Mount Sinai New York New York USA

Section of Pulmonary Critical Care Sleep Medicine Baylor College of Medicine Houston TX USA

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