Race-Neutral Data Show Biologics’ Benefits for Kids’ Asthma

Asthma biologics significantly improved lung function in children with asthma using race-based reference points, based on new data from 115 individuals.

Data on the effect of biologics on lung function in pediatric asthma are limited, and the main previous study of this relationship, the VOYAGE trial, was limited by its reliance on older, race-specific spirometry equations, according to Ken Wu, medical student at Indiana University School of Medicine in Indianapolis.

Newer, race-neutral reference equations prevent the systematic underestimation of asthma severity in Black patients and consequently provide a more accurate assessment of therapeutic benefits, said Wu. “Our study offers a novel contribution to the literature as the first known to utilize race-neutral equations to evaluate lung function following biologic therapy in a pediatric asthma population,” he said.

In a new study, presented at the American Thoracic Society (ATS) 2026 International Conference, the researchers conducted a real-world analysis with race-neutral reference equations developed by the Global Lung Function Initiative to assess the effect of biologics on lung function. They reviewed data from 115 pediatric patients with asthma who started biologics for the first time between 2015 and 2025. Their analysis included height, weight, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratios. The mean age of the patients was 11.4 years, 52% were male, and 62% were Black. A majority (97 patients) received dupilumab; 13 received omalizumab, and 5 received mepolizumab.

The analysis included an average of three spirometry measures 1 year before starting biologics and an average of four measures during the year after starting biologics.

Treatment with dupilumab was associated with a significant improvement in lung function, with an increase in the average FEV₁ from 86.4 percent-predicted prior to biologics to 91.7 after biologics (mean difference, 5.31; P = .044). No significant differences appeared among omalizumab or mepolizumab patients, likely because of the small numbers, the researchers noted.

Overall, in a linear mixed model adjusting for biologic type, FEV₁ remained significantly higher after use of biologics than in the period prior to use (97.9 vs. 92.5), with a mean difference of 5.37 (P = .039).

The primary finding that dupilumab improved the percent-predicted FEV₁ by 5.31 is considered a modest effect size and mainly aligns with previous research, said Wu. “We are currently in the process of conducting additional analysis of whether there is a difference in lung function when we use the older race-specific equations versus our current findings with the newer race-neutral equations,” he said.

The findings were limited by several factors, including the relatively small study population and inclusion of only 3 types of biologics, with samples of omalizumab and mepolizumab that were underpowered to detect differences in lung function, said Wu. Additional studies with larger sample sizes, more biologics (including benralizumab and tezepelumab), and longer follow-up periods are needed to compare benefits across agents, he said.

Promising Implications for Practice

The ATS has recommended abandoning the previous race-adjusted pulmonary function test norms, said Timothy Joos, MD, who practices internal medicine and pediatrics at a community health center in Seattle.

These norms assigned smaller lung volumes to Black and Asian individuals and tended to underestimate lung disease in these populations, said Joos, who was not involved in the new study.

The current study, though small, showed with race-neutral reference equations that biologic agents significantly improved FEV1 values in children with severe asthma, said Joos. The association was especially strong with dupilumab, used by 85% of the patients, he noted. However, additional studies are needed with larger patient populations and other biologic agents to confirm the results, he said.

The study was supported by the Indiana Clinical and Translational Sciences Institute. The previous VOYAGE trial received funding from Sanofi and Regeneron Pharmaceuticals. The researchers reported having no financial conflicts to disclose. Joos reported having no financial conflicts to disclose.

A version of this article first appeared on Medscape.com.