<p>Anti-IL5 Therapies for Severe Eosinophilic Asthma: Literature Review and Practical Insights</p>

Abstract

Severe refractory asthma (SRA) still has a high economic and social impact, including a reduction in quality of life (QoL), productivity, a greater risk of exacerbations and emergency department (ED) visits. Another major issue is the need of oral corticosteroids (OCS), often due to a poor response to standard therapies or the lack of indication for currently available biological drugs. A thorough understanding of the immunological pathways and eosinophilopoietic processes allows a correct application of the new pharmacological strategies and leads to better clinical responses. For these unmet needs, several monoclonal antibody (mAb) drugs have been introduced over the past few years. These are mainly available for allergic and especially eosinophilic uncontrolled refractory asthma. As the number of therapeutic options increases, the choice of biological drugs can be made only after careful considerations of the particular asthma endotype, patients’ comorbidities and clinical data. The selection of the correct therapeutic option can therefore be guided after a careful evaluation of the particular endotype and phenotype, from the combined evaluation of inflammatory biomarkers, clinical picture and comorbidities. The careful evaluation of all these parameters can therefore help the physician in the optimal management of these complex patients, for whom it is often possible to achieve exceptional results by managing the available options in the best possible way. The aim of this review is to define the positioning of the biological drugs currently available for type 2 asthma, with a special focus on options for eosinophilic asthma in the context of the most recent knowledge of immunological pathways.

Prevalence of eosinophilic, atopic, and overlap phenotypes among patients with severe asthma in Saudi Arabia: a cross-sectional study

“…As an example, the present study reported a high percentage of participants with the eosinophilic phenotype who experienced ≥ 3 asthma exacerbations over a period of 12 months. Anti-IL-5 or anti-IL-5 receptor biologic therapy has been shown to reduce the number of exacerbations in patients with eosinophilic asthma and would therefore likely benefit this patient population [ 38 ]. While biologic therapy is beneficial for patients with eosinophilic asthma, a recent study conducted in Brazil found that many patients with severe asthma were not eligible for approved biologics and that those who were eligible may not be able to access them [ 39 ].…”

Real world effectiveness of benralizumab on respiratory function and asthma control

“…This also has an impact on the OCS-related complications with a consequent reduction in the related economic costs, thanks to the significant steroid-sparing effect of biologics [2][3][4]. In the field of severe eosinophilic asthma (SEA), two important pharmacological options have been available for a few years, namely mepolizumab and benralizumab, and more recently also dupilumab has become usable [5]. These are effective and safe monoclonal antibodies (mAbs), but for which there have been no head-to-head comparative studies yet.…”

Treatment Response Biomarkers in Asthma and COPD

“…For this group of patients, treatment with monoclonal antibodies targeting some of the cytokines can significantly improve various clinical outcomes in patients with severe asthma [ 16 ]. Omalizumab (humanized, monoclonal antibody that binds to circulating IgE molecules) was the first approved treatment for patients with allergic asthma, followed by treatments targeting the IL-5 pathway: mepolizumab (monoclonal antibody that binds to IL-5), reslizumab (also a monoclonal antibody that binds specifically to IL-5), and benralizumab (monoclonal antibody that binds directly to the IL-5-receptor α on eosinophils) [ 17 ]. Dupilumab is the most recently approved biological treatment for severe asthma.…”