BRIEF RESEARCH REPORT article
Front. Allergy
Sec. Asthma
Volume 6 - 2025 | doi: 10.3389/falgy.2025.1672424
This article is part of the Research TopicExploring Biologics: A New Frontier in Managing Pediatric Severe AsthmaView all articles
Clinical, functional, and laboratory course of children and adolescents with severe asthma after discontinuation of biologics
Provisionally accepted
Valentina Agnese Ferraro1,2,3*
Raimondo Junior Castaldo1,2,3Fiorenza Alfier1,2,3Margherita Amadi1,2,3Chiara Pertoldi1,2,3Valentina Tonazzo1,2,3Stefania Zanconato1,3
Silvia Carraro1,2,3- 1Unit of Pediatric Allergy and Respiratory Medicine, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy, Padova, Italy
- 2University of Padua, Padua, Italy
- 3Azienda Ospedale Universita Padova, Padua, Italy
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Background: Although the benefits of biologics in severe asthma are well established, the optimal strategy to discontinue therapy remains controversial.Aim: to evaluate clinical, functional, and laboratory course of children and adolescents with severe asthma after biological therapy withdrawal due to sustained good control. Secondary aim was to identify clinical or inflammatory markers predictive of asthma control after discontinuation.Materials and methods: this retrospective study included patients 6-19 years with severe asthma followed at the University Hospital of Padua in whom a biologic therapy was discontinued after at least 24 months of treatment. Clinical (GINA, CASI, exacerbations), functional (spirometry), inflammatory (FeNO, IgE, eosinophils), pharmacological (ICS dosage), and quality-of-life (PAQLQ) data were collected over a 24-month follow-up.Results: twenty-three asthmatic patients (34.8% female) were included. 19 treated with Omalizumab, 3 Dupilumab, and 1 Mepolizumab. At withdrawal, all had well-controlled asthma (GINA and CASI 3). Clinical control scores, spirometry, PAQLQ remained stable overtime. No exacerbation increase was observed. One patient resumed biologic therapy. An increase in eosinophil counts was found in patients classified as not fully controlled at 24 months.Conclusions: clinical and functional benefit of biologics may persist for up to 24 months after biologic withdrawal. After biologic discontinuation, most children maintained symptom control and good quality of life, suggesting that biologic therapy may be stopped in appropriately selected cases. At the same time a close follow-up, including assessment of clinical control, functional parameter and biomarkers, is needed to promptly identify signs associated with possible loss of control.
Keywords: Severe asthma, Children, Biologic discontinuation, markers, Asthma control
Received: 24 Jul 2025; Accepted: 08 Aug 2025.
Copyright: © 2025 Ferraro, Castaldo, Alfier, Amadi, Pertoldi, Tonazzo, Zanconato and Carraro. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Valentina Agnese Ferraro, Unit of Pediatric Allergy and Respiratory Medicine, Women's and Children's Health Department, University Hospital of Padova, Padova, Italy, Padova, Italy
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