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More than half of severe asthma patients don't stick with their first biologic, a real-world Mayo Clinic study found. Dupilumab was the most prescribed first-line option, while reslizumab saw the highest discontinuation rate. Notably, one-third of switches happened while patients were actually improving — often driven by insurance denials or cost.
A large retrospective study out of Mayo Clinic found that the majority of severe asthma patients don't stay on their first biologic long-term. Analyzing over 4,200 patients treated between 2003 and 2025, researchers found that only 38.7% continued their initial biologic, while 44% discontinued and 17.2% switched to a different one. Dupilumab was the most commonly prescribed first biologic and also had one of the lowest discontinuation rates.
What's striking is that clinical failure doesn't tell the whole story. A full one-third of switches happened while patients were actually getting better — and in insurance-related switches, 96% occurred during a period of improvement. Nearly one-third of patients had a biologic ordered that was never started, most often due to insurance denial or cost barriers.
By the Numbers:
Why it matters: With no head-to-head trials comparing severe asthma biologics, clinicians rely on trial and error — a process that delays disease control, drives up costs, and exposes patients to unnecessary side effects. This study highlights the urgent need for better biomarkers and more individualized treatment strategies, while also spotlighting how insurance and cost barriers can disrupt care even when treatments are working.
