Biologics for severe asthma and beyond

Mümmler, Carlo; Milger, Katrin

doi:10.1016/j.pharmthera.2023.108551

Cited by 4 publications

(3 citation statements)

References 138 publications

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“…When used in the right patients, these drugs improve lung function, quality of life, and asthma control while lowering the need for OCS and reducing asthma exacerbations [22]. Under continuous biologic therapy, a percentage of individuals with severe asthma may even experience clinical remission [23–25]. In the context of the Adult German Asthma Net Severe Asthma Registry Cohort, Milger et al [26] detected clinical remission after 12 months (no OCS plus no exacerbations plus satisfactory symptom control) in 37.6% of severe asthma patients treated with biologics, and in 17.2% of those treated without biologics.…”

Section: Lightsmentioning

confidence: 99%

Clinical remission in severe asthma: lights and shadows on an ambitious goal

Pelaia,

Zannoni,

Paoletti

et al. 2024

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review The aim of this study was Describe the latest evidence related to the concept of clinical remission in patients with severe asthma, focusing on the lights and shadows of this concept. Recent findings The idea of clinical remission in severe asthma patients brings about a significant shift in the way asthma is treated and managed. Although there has yet to be unanimous agreement among various scientific societies on the precise definition, this concept can be extremely useful in advancing the treatment of the disease. Summary Asthma is a common respiratory condition that affects more than 300 million people globally. It has variable symptoms and severity levels, with about 10% of patients experiencing severe asthma. While there have been advancements in treatment, severe asthma poses significant challenges. Recent approaches have focused on achieving clinical remission, which goes beyond symptom control to address underlying inflammation and biological processes. Clinical remission criteria include the absence of symptoms, reduced medication usage, and normalized inflammatory markers. Various biologic therapies show promise, with some patients achieving remission. However, remission's definition varies globally, hindering standardization and a valid comparison. Standardizing remission criteria and refining predictive factors are crucial for effective asthma management. Overall, achieving clinical remission offers hope for improved long-term outcomes in severe asthma patients.

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Section: Lightsmentioning

confidence: 99%

Clinical remission in severe asthma: lights and shadows on an ambitious goal

Pelaia,

Zannoni,

Paoletti

et al. 2024

Current Opinion in Allergy &Amp; Clinical Immunology

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“…Severe asthma patients experience highest overall morbidity, impact on quality of life (QoL), and high healthcare costs [4–6]. A surge of knowledge in asthma inflammatory pathways has led to the development of six monoclonal antibody therapies for these patients [7 ▪▪ ,8]. Clinical trials of these therapies, collectively called biologics, highlight their effectiveness in disease control through lung function improvement, reduction in asthma exacerbations and dependence on oral corticosteroids (OCS) [9–17,18 ▪ ,19,20,21 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

“…Currently, there are six biologics for asthma, approved by the FDA at various timepoints: omalizumab (2003), mepolizumab (2015), reslizumab (2016), benralizumab (2017), dupilumab (2018), tezepelumab (2021) (Table 1) [7 ▪▪ ]. Given their ever-increasing popularity in severe asthma [23 ▪▪ ], it is important to consider their long-term durability and safety.…”

Section: Introductionmentioning

confidence: 99%

Long-term safety, durability of response, cessation and switching of biologics

Mohan,

Qiu,

Lugogo

2024

Current Opinion in Pulmonary Medicine

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Purpose of review Severe asthma patients suffer from decreased quality of life, and increased asthma symptoms, exacerbations, hospitalizations, and risk of death. Biologics have revolutionized treatment for severe asthma. However, with multiple biologic agents now available, clinicians must consider initial selection the long-term effectiveness of biologics. Additionally, patients have overlapping eligibilities and clinicians may consider switching between biologics for improved response. Finally, careful assessment of biologics cessation is needed for severe asthma patients who depend on these add-on therapies for asthma control. Recent findings Evidence for long-term durability and safety varies by biologic agent. In general, initial benefits noted from these agents (ex. exacerbation reduction) is, at minimum, sustained with long term use. Rates of adverse events and serious adverse events, including those requiring cessation of a biologics are low with long term use. Further studies are needed to understand the development of antidrug antibodies but currently their prevalence rates are low. Adverse events and insufficient efficacy are common reasons for biologic cessation or switching. Discontinuation maybe associated with waning of benefits but can be considered in certain situations. Biologic switching can be associated with improved asthma control. Summary Biologics are safe and effective long-term therapies for the management of asthma. Discontinuation must be carefully considered and if possible avoided. Reasons for insufficient efficacy must be evaluated and if needed, biologic switching should be considered.

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