SYSTEMATIC REVIEW article
Front. Med.
Sec. Pulmonary Medicine
Comparative Efficacy and Safety of Biologic Therapies in Pediatric Asthma: A comprehensive Systematic Review
College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Abstract
Background: Asthma remains one of the most prevalent chronic diseases among children, with severe cases posing significant challenges to symptom control, and quality of life (QoL). Biologic therapies have emerged as effective alternatives for severe asthma unresponsive to conventional therapies. However, limited evidence exists for their comparative efficacy and safety in pediatric populations. This systematic review aims to evaluate the efficacy and safety of five major biologic agents in children and adolescents with uncontrolled asthma. Methods: A systematic literature search was conducted in PubMed, Web of Science, and Embase up to June 2025. Eligible studies included randomized and open label extensions involving pediatric asthma patients treated with at least one of the five biologic therapies including Dupilumab, Omalizumab, Mepolizumab, Lebrikizumab and Benralizumab. Outcomes assessed included exacerbation rates, lung function, asthma control, QoL, and adverse events. Risk of bias was assessed using RoB 2.0 and MINORS tools. Results: This review included Twenty-five studies. Dupilumab consistently showed the most robust outcomes, significantly reducing exacerbations (by up to 64.7%), improving ACQ-7 scores, pulmonary function, and QoL. Omalizumab also showed reduced exacerbations and improved symptom control and QoL, with debatable results in pulmonary function. Mepolizumab demonstrated moderate benefits with variable efficacy and higher SAE rates. Benralizumab and Lebrikizumab yielded modest improvements in clinical outcomes. Safety profiles were generally favorable across biologics, with mild-to-moderate adverse events. Conclusion: Among the reviewed biologics, Dupilumab showed the most consistent and sustained efficacy across clinical, and patient-reported outcomes in pediatric asthma. Omalizumab also proved effective, particularly in allergic and virus-induced exacerbations. This review underscores the importance of phenotype-directed therapy and supports dupilumab as a preferred option for long-term management of severe pediatric asthma.
Summary
Keywords
Asthma, Asthma exacerbation Safety, biologic therapy, Pediatrics, Quality of Life
Received
10 October 2025
Accepted
11 February 2026
Copyright
© 2026 Alzayed. 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: Abdullah Alzayed
Disclaimer
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