AUTHOR=Xiao Qionghua , Huang Yuanming , Xue Bingyu , Wang Minghang 

TITLE=The efficacy and safety of biologics for patients with severe asthma: an umbrella review of systematic reviews and meta-analyses

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1573596

DOI=10.3389/fmed.2025.1573596

ISSN=2296-858X

ABSTRACT=IntroductionMany systematic reviews and meta-analyses (SR/MAs) have evaluated the efficacy of biologic therapy for severe asthma. However, the quality of these SR/MAs is unclear, which may influence the selection of biologics and lead to misleading clinical decisions. Therefore, this umbrella review aims to objectively evaluate the quality of these SR/MAs and reassess the efficacy of biologic therapy for severe asthma.MethodsA systematic search was performed in PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE databases. Literature screening and data extraction were conducted according to inclusion and exclusion criteria. Then, we evaluated the methodological quality of these SR/MAs using A MeaSurement Tool to Assess Reviews 2 (AMSTAR 2). In addition, the re-meta-analysis of study outcomes was performed applying R 4.3.3 software.ResultsThe umbrella review included 23 SR/MAs. In the evaluation of methodological quality, five SR/MAs were rated as high quality, one was rated as moderate, and 17 were rated as low or critically low. In terms of efficacy evaluation, biologics were associated with a 45% reduction in AER (RR: 0.55; P < 0.0001), a 57% reduction of asthma-related hospitalizations (RR: 0.43; P < 0.0001), an increase in the forced expiratory volume in 1 s (FEV1) of 0.13 L (P < 0.0001), a reduction in asthma control questionnaire (ACQ) scores by 0.33 points (P < 0.0001), an increase in asthma quality of life questionnaire (AQLQ) scores by 0.26 points (P < 0.0001), and a reduction in fractional exhaled nitric oxide (FeNO) levels by 22.52 ppb (P < 0.0001). In terms of safety evaluation, overall, biologics demonstrated favorable safety.ConclusionThis umbrella review has demonstrated that biologics have good efficacy and acceptable safety in the treatment of severe asthma. However, the methodological quality of included SR/MAs was mostly low or critically low, suggesting that we need to be cautious when interpreting the results of this study. Therefore, more high-quality SR/MAs are needed to provide robust clinical evidence.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024607393.