Adults with severe asthma were more likely to discontinue biologic therapy based on nonclinical reasons than based on side effects or perceived ineffectiveness, according to data from more than 7000 individuals presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2026 Annual Meeting. 

The reasons for stopping biologic therapies in severe asthma remain poorly understood, wrote Isabella Novoa Caicedo, MD, of the Mayo Clinic, Rochester, Minnesota, and colleagues. To fill this data gap, the researchers reviewed data from a real-world community setting, using 7450 electronic medical records from a US-based network of specialty asthma and allergy clinics. 

The study population included adults with a documented diagnosis of severe asthma and at least one biologic prescription. Those who did not renew a prescription but were followed in a clinic were classified as having stopped the therapy. Other reasons for treatment discontinuation were based on chart reviews of clinical notes.

Approximately one third (36.8%, 2742 patients) discontinued biologics during the study period. Across all biologics, nonclinical factors were the most common reasons for discontinuation, mostly related to payer challenges. Omalizumab and benralizumab were the most frequently discontinued biologics. The most common clinical reasons for discontinuation across all biologics were side effects for omalizumab patients and lack of treatment effectiveness for tezepelumab and mepolizumab patients.

Symptom remission was the least-cited reason for stopping treatment, the researchers noted. The results illustrate the need for continuous assessment of nonclinical as well as clinical factors that may prompt patients to stop treatment, they concluded.

Real-World Experience Reveals Challenges

“Biologics have significantly changed how we manage severe asthma, yet reasons for stopping these therapies in practice are not well described,” said Arianne K. Baldomero, pulmonologist and assistant professor of medicine at the University of Minnesota, Minneapolis. “The current study can inform policy, payer decisions, and health system interventions to address discontinuation, particularly when treatment is beneficial,” said Baldomero, who was not involved in the study.

Baldomero was not surprised that payer challenges were the most common reason for stopping biologics. “Issues including insurance coverage and out-of-pocket costs align with what I have heard from colleagues in community practice and reflect broader access barriers for high-cost therapies,” she said.

Stopping effective biologics for nonclinical reasons may worsen asthma control and increase asthma exacerbations, Baldomero told Medscape Medical News. “This can translate into greater healthcare utilization, including more frequent ED visits, primary care encounters, and pulmonary specialty care visits,” she said.

“Future work should prospectively determine when and in whom biologics can be safely de-escalated, including defining clinical characteristics and biomarkers that identify appropriate candidates for discontinuation,” Baldomero said. “Additional studies are also needed to clarify which patients require long-term or lifelong biologic therapy vs a time-limited treatment course,” she said.

The study was received no outside funding. The researchers and Baldomero had no financial conflicts to disclose.