New and emerging drug treatments for severe asthma

Abstract

Asthma is a common chronic inflammatory condition of the airways affecting over 300 million people world-wide. In 5%-10% of cases, it is severe, with disproportionate healthcare resource utilization including costs associated with frequent exacerbations and the long-term health effects of systemic steroids. Characterization of inflammatory pathways in severe asthma has led to the development of targeted biological and small molecule therapies which aim to achieve disease control while minimizing corticosteroid-associated morbidity. Herein, we review currently licensed agents and those in development, and speculate how drug therapy for severe asthma might evolve and impact on clinical outcomes in the near future.

HSP90 inhibitor geldanamycin reverts IL-13– and IL-17–induced airway goblet cell metaplasia

“…In contrast, in individuals with Th2-low asthma, chronic bronchitis, or cystic fibrosis, the mechanisms of goblet cell metaplasia are poorly understood. Targeted asthma therapy trials involving antibodies against IgE, IL-4/IL-13, IL-4R, IL-5, IL-5R, IL-17, and others (37) have had variable outcomes (38), probably because they target inflammatory pathways that interact with each other in complex ways.…”

Situation (nearly) vacant!

“…Additionally, a blood eosinophils of 1.200 × 109/L or more was associated with an increased risk of a further asthma attack (hazard ratio 1.8, 95% confidence interval 1.1‐2.9, P = .02) (Figure ). Might more aggressive therapy with corticosteroids or biologicals prevent these subsequent asthma attacks in patients with elevated eosinophil counts?…”

“…Might more aggressive therapy with corticosteroids or biologicals prevent these subsequent asthma attacks in patients with elevated eosinophil counts? 7,8 A major trigger for asthma attacks is viral infections. Ravi and colleagues have looked at gene expression over time in nasal epithelial cells challenges in vivo with rhinovirus-16 to observe how nasal symptoms and viral clearance are related.…”

Welcome to 2020

“…This effectively blocks the action of both IL‐4 and IL‐13. Given their central role in allergic responses, it is not surprising that Dupilumab has a potential role in the therapy of many allergic diseases …”