Abstract Rationale Older adults with asthma are underrepresented in clinical trials of biologic therapies, limiting evidence-based guidance for this population. We aimed to assess national trends in biologic therapy use and outcomes among older adults with asthma. Methods We performed a nationwide, retrospective, new-user cohort study using data from the second-largest health maintenance organization in Israel. Adults with asthma who initiated biologic therapy between 2015 and 2023 were included. We analyzed trends in biologic use among older adults (75 years) and compared clinical outcomes with younger patients using a general linear repeated measures model. Outcomes were assessed with and without propensity score matching for confounders including biologic type, baseline exacerbation rates, and demographic characteristics. Results Of 1,126 patients initiating biologic therapy and included in our study, 94 (8.3%) were aged 70 years. The proportion of older adults among biologic initiators increased over time (Figure 1, p = 0.010), peaking at 14.2% during 2023. Between 2020-2023, anti-IL-5 therapies were more frequently prescribed to older adults (39% vs. 24%, p 0.01) and dupilumab vice versa (39% vs. 54%), with no differences in baseline eosinophil counts or allergy status between the groups. At baseline, older adults had more 1-year asthma related emergency department visits (48% vs. 38%, p = 0.02) and similar overall exacerbations. Following biologic therapy, the annualized exacerbation rate decreased from 2.26 to 1.01 (51% reduction) in older adults, and from 2.37 to 0.96 in younger adults (59% reduction). The relative reduction did not differ significantly between groups (p for interaction =0.217). On the contrary, older adults had a smaller decrease in maintenance OCS cessation (27% reduction vs. 38%, p for interaction =0.023). Comparisons were consistent after propensity matching. Conclusion Biologic therapies were similarly effective in reducing exacerbations among older and younger adults with asthma, supporting their use in older populations. This abstract is funded by: None
Bar-Shai et al. (2026) studied this question.