Two Shots a Year Instead of Monthly: A New Biologic Option for Severe Eosinophilic Asthma

Key Takeaways

• The FDA approved depemokimab, the first twice-yearly biologic for severe asthma with an eosinophilic phenotype, as an add-on maintenance treatment for patients age 12 and older.
• In Phase 3 trials, it reduced annual asthma exacerbations by up to 58 percent compared to placebo, and cut hospitalizations or emergency visits by 72 percent, with a safety profile similar to placebo.
• Unlike existing IL-5-targeted biologics that require dosing every four to eight weeks, this option requires only two doses per year, which may meaningfully improve consistency of use for patients who struggle with frequent injection schedules.
• It is intended for a specific subgroup, severe asthma driven by eosinophilic inflammation, identified through blood eosinophil counts and clinical history, not for asthma broadly.

Why dosing frequency is a bigger deal than it sounds

Biologic medications have meaningfully changed severe asthma care over the past decade, offering real symptom control and exacerbation reduction for patients who continue to struggle despite standard inhaled medications. The tradeoff has always been treatment burden. Most existing biologics require an injection every two to eight weeks, indefinitely, and that frequency itself becomes a real barrier over time. Missed or delayed doses reduce effectiveness, and the ongoing commitment of frequent injections is part of why biologics remain underused even among patients who would likely benefit from them.

A treatment requiring only two doses per year addresses that burden directly, which matters not just for convenience but for the more basic problem of patients actually staying on treatment consistently over time.

How this fits into severe asthma treatment

Who this is for

This is not a treatment for typical, well-controlled asthma. It is specifically intended for patients with severe asthma driven by an eosinophilic phenotype, meaning inflammation characterized by elevated eosinophils, a type of white blood cell involved in type 2 inflammation. That phenotype is confirmed through blood eosinophil counts and clinical history, alongside a pattern of exacerbations despite treatment with medium or high dose inhaled corticosteroids.

What the trial data showed

The approval was supported by the Phase 3 SWIFT trials, which found significant reductions in annualized asthma exacerbations compared to placebo, along with meaningful reductions in exacerbations severe enough to require hospitalization or an emergency department visit. Roughly half of the estimated 2 million Americans living with severe asthma continue to experience frequent exacerbations and hospitalizations despite current treatment, which is the population this kind of option is aimed at.

The biology behind this treatment isn't new, we've had IL-5-targeted biologics for years. What's genuinely different is the dosing. For a patient managing severe asthma, going from an injection every month to two visits a year is a real quality of life change, and in practice it often means someone actually stays on their treatment consistently instead of falling off after a few months.

— Yuliya Leviyev, NP, Allergy Asthma

What this means if you have severe asthma

If you have severe asthma and continue to have exacerbations despite inhaled controller therapy, or if you have been on a biologic before but struggled with the frequency of injections, this is worth a conversation at your next visit. Confirming an eosinophilic phenotype through blood testing is a required first step, since this treatment is specifically matched to that inflammatory pattern rather than being a general severe asthma option.

When to book a visit

Consider scheduling an evaluation if you continue to have asthma flares or need oral steroids despite consistent use of your inhaled controller medication, if you have never had eosinophil testing to characterize your asthma phenotype, or if you have previously discussed biologics for asthma but the injection schedule was a barrier to starting or continuing treatment.

Disclaimer: This content is educational and does not substitute for medical advice. Always consult your physician for personal medical questions.