How to monitor response to biologics in children with severe asthma

Severe paediatric asthma imposes a substantial health and financial burden. Biologics-monoclonal antibodies targeting specific asthma inflammatory pathways, are transforming severe asthma management. Currently approved biologics for paediatric use (≥6 or ≥12 years of age) include anti-immunoglobulin E (omalizumab), anti-interleukin (IL)-5 (mepolizumab), ultra-long acting anti-IL5 (depemokimab), anti-IL-5 receptor (benralizumab), anti-IL4/IL-13 (dupilumab), and anti-thymic stromal lymphopoietin (TSLP) (tezepelumab). While clinical trials have shown promising results, real-world data on long-term efficacy and safety in children and adolescents remain limited. Moreover, guidelines for initiating, monitoring biologics and assessing treatment response varies across countries lacking consensus. This is the second in a series of narrative reviews on biologics in severe paediatric asthma. The first review summarised key clinical trials findings and offered practical guidance for initiating therapy. In this review, we focus on strategies for monitoring treatment response, the role of asthma biomarkers and the potential of emerging therapies. We also highlight current research gaps and future directions to optimise biologics use in children and adolescents with severe asthma.