Abstract
This review aims to analyze biologic treatments for pediatric asthma, along with their effects on T2-high inflammation, together with outcomes of omalizumab, mepolizumab, and dupilumab. This review examined recent biomarker advancements, together with endotype patterns, while analyzing early treatment opportunities that might transform asthma's natural course. In conclusion, the advancement in biologic therapies is offering significant progress for personalized severe asthma treatment among pediatrics, especially for the T2-high endotype. Biologics such as omalizumab, mepolizumab, dupilumab, benralizumab, and tezepelumab have been reported to reduce severe asthma exacerbations, with reassuring short-term safety profiles among children and adolescents (pediatrics). However, the treatment efficacy of these biologics is limited for T2-low and non-T2 asthma endotypes, emphasizing the need for new biologic therapies that target these endotypes. Literature review also highlights the emerging treatment regimens for non-T2 endotypes, such as tezepelumab, ecleralimab, and astegolimab (IL-33), which influence both T2 and non-T2 pathways. The integration of precision medicine and multi-omics data specific to patients is not only providing promising results, but also helping to refine patient selection and patient-specific treatment. Furthermore, the identification of novel predictive biomarkers through advanced omics methods is essential for a more personalized approach. Ultimately, the continued advancement and strategic implementation of biologic therapies hold the potential to revolutionize the management of severe pediatric asthma, leading to reduced exacerbations and corticosteroid use, improved quality of life, and more precise treatment strategies tailored to individual patient profiles. Moreover, future research should continue to address the challenges related to long-term safety, cost-effectiveness, and equitable access, which are vital to realizing the true potential of biologic therapies in treating pediatric asthma.