Current capabilities of targeted biological therapy for severe bronchial asthma and prospects for personalized selection

Starodubtseva I.A., Lesina V.S., Cherenkova O.V., Mubarakshina O.A., Sharapova Yu.A.

1) N.N. Burdenko Voronezh State Medical University, Voronezh, Russia; 2) Voronezh Regional Clinical Hospital No. 1, Voronezh, Russia

Severe bronchial asthma (BA) is characterized by heterogeneity in inflammatory mechanisms, clinical course, and treatment response, necessitating a personalized approach to therapy. Advances in the understanding of the molecular mechanisms of BA have enabled the introduction of genetically engineered biological therapies targeting key components of the inflammatory cascade. Primary therapeutic targets include immunoglobulin E (IgE), interleukin-5 (IL-5) and its receptor (IL-5Rα), the interleukin-4 receptor alpha subunit (IL-4Rα)—which mediates IL-4 and IL-13 signaling—and thymic stromal lymphopoietin (TSLP). This review outlines the mechanisms of action and the evidence base for the use of omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and tezepelumab. It also examines results from key randomized clinical trials and real-world clinical practice data regarding the impact of biological therapy on exacerbation rates, asthma control, lung function, and the need for systemic glucocorticosteroids. Particular attention is paid to the personalized selection of therapy, taking into account allergic sensitization, blood eosinophil counts, fractional exhaled nitric oxide (FeNO) levels, the need for systemic glucocorticosteroids, and comorbidities. The article discusses drug selection options when multiple potential therapeutic targets are present, as well as the limitations of direct and indirect comparisons regarding the efficacy of biological agents. The modern strategy for biological therapy in severe asthma relies on a comprehensive assessment of clinical characteristics, biomarkers, and comorbidities, enabling the selection of the most appropriate targeted therapy for the individual patient.

For citations: Starodubtseva I.A., Lesina V.S., Cherenkova O.V., Mubarakshina O.A., Sharapova Yu.A. Current capabilities of targeted biological therapy for severe bronchial asthma and prospects for personalized selection. Pharmateca. 2026;33(6):8-16. (In Russ.). DOI: 
https://dx.doi.org/10.18565/pharmateca.2026.6.8-16

Authors’ contribution: I.A. Starodubtseva – article concept, scientific editing. V.S. Lesina – data collection and processing, manuscript drafting. O.V. Cherenkova – article concept, data collection and processing, manuscript drafting. O.A. Mubarakshina – scientific editing. Yu.A. Sharapova – data collection and processing.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.

Keywords

About the Authors

Irina A. Starodubtseva, Dr. Sci. (Med.), Professor at the Department of Outpatient Therapy, N.N. Burdenko Voronezh State Medical University, Voronezh, Russia; starodubtsevairina1@gmail.com, ORCID: https://orcid.org/0000-0002-4665-2966
Viktoriya S. Lesina, Pulmonologist, Department of Pulmonology, Voronezh Regional Clinical Hospital No. 1, Voronezh, Russia; ORCID:
https://orcid.org/0000-0001-8231-6591
Olga V. Cherenkova, Cand. Sci. (Med.), Associate Professor, Department of Clinical Pharmacology, N.N. Burdenko Voronezh State Medical University, Voronezh, Russia; cherenkova.o.v@yandex.ru, ORCID: https://orcid.org/0000-0001-5320-2720
Olga A. Mubarakshina, Cand. Sci. (Med.), Associate Professor, Department of Clinical Pharmacology, N.N. Burdenko Voronezh State Medical University, Voronezh, Russia; mubarakshina@mail.ru, ORCID: https://orcid.org/0000-0001-6799-6322 (corresponding author)
Yuliya A. Sharapova, Cand. Sci. (Med.), Associate Professor, Department of Hospital Therapy and Endocrinology, N.N. Burdenko Voronezh State Medical University, Voronezh, Russia; shajulia2007@yandex.ru, ORCID: https://orcid.org/0000-0002-4269-2153

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