During the last decades, new treatments targeting disease mechanisms referred as biologics have been introduced in the therapy of asthma and currently, five monoclonal antibodies have been approved. Although these therapeutic agents have been formulated to target specific asthma endotypes, it is often difficult for the treating physician to identify which patient is the best candidate for each one of these specific treatments especially in the clinical scenario of a patient in whom clinical characteristics overlap between different endotypes, allowing the selection of more than one biologic agent. As no head-to-head comparisons between these biologics have been attempted, there is no evidence on the superiority of one biologic agent over the other. Furthermore, a physician's first therapeutic decision, no matter how carefully has been made, may often result in suboptimal clinical response and drug discontinuation, indicating the need for switching to a different biologic. In this short review, we discuss the available evidence regarding the switching between biologics in patients with severe asthma and we propose a simple algorithm on switching possibilities in case that the physicians' initial choice is proven not to be the best.

中文翻译：

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在严重哮喘患者中切换生物制剂。当第一选择未被证明是最好的时

在过去的几十年中，针对称为生物制剂的疾病机制的新疗法已被引入哮喘的治疗中，目前已有五种单克隆抗体获得批准。尽管这些治疗剂已针对特定的哮喘内型进行了配制，但治疗医师通常难以确定哪些患者是这些特定治疗中的每一种的最佳候选者，尤其是在临床特征重叠的患者的临床情况下不同的内型，允许选择一种以上的生物制剂。由于尚未尝试在这些生物制剂之间进行直接比较，因此没有证据表明一种生物制剂优于另一种。此外，无论医生做出的第一个治疗决定多么谨慎，通常可能导致次优的临床反应和药物停药，表明需要换用不同的生物制剂。在这篇简短的综述中，我们讨论了有关在严重哮喘患者中切换生物制剂的现有证据，并提出了一个简单的算法来说明切换可能性，以防医生的初始选择被证明不是最好的。