Global prevalence of eligibility for biologic therapy in ATS/ERS-defined severe asthma: A systematic review
Bibliographic record
Abstract
Background: Biologic therapies improve outcomes in severe asthma, but eligibility criteria vary globally, influencing the proportion of patients who qualify. We systematically reviewed studies to estimate the global prevalence of biologic eligibility in patients aged ≥12 years with American Thoracic Society / European Respiratory Society (ATS/ERS)-defined severe asthma and the proportion eligible for each biologic. Methods: Following PRISMA guidelines (PROSPERO CRD42023393897), we searched MEDLINE, EMBASE, Web of Science, and ClinicalTrials.gov for studies published between 2000 and 2025 that reported the proportion of biologic-naïve, severe asthma patients eligible for omalizumab, mepolizumab, benralizumab, reslizumab, dupilumab, or tezepelumab. Two reviewers independently screened studies, extracted data on eligibility proportions and criteria, and assessed quality using the AXIS tool. Results: Ten observational studies, including 3500 patients with ATS/ERS-defined severe asthma, met the inclusion criteria. Across all studies, 1770 patients (51%) were eligible for at least 1 biologic, though estimates ranged widely from 24% to 91%, largely reflecting differences in national eligibility criteria. Omalizumab eligibility was reported in 8 studies (16%, range 6%-66%), mepolizumab in 9 studies (27%, 19%-78%), benralizumab in 6 studies (25%, 19%-53%), reslizumab in 6 studies (17%, 6%-41%), and dupilumab in 2 studies (41%, 37%-75%). No study assessed tezepelumab. Overall, the lowest eligibility (24%) was reported in the European IDEAL cohort due to stringent exacerbation and biomarker criteria, whereas the highest (91%) was observed in a Canadian single-centre cohort using less restrictive national regulatory criteria. Conclusion: Globally, approximately 51% of adults with severe asthma are eligible for biologic therapy, excluding tezepelumab. Among available biologics, eligibility is generally higher for anti-IL5/IL5Rα therapies than for anti-IgE, and appears highest for anti-IL4Rα, although data for the latter remain limited.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.027 | 0.082 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.012 | 0.012 |
| Bibliometrics | 0.011 | 0.012 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".