Prediction of response to biological treatment with monoclonal antibodies in severe asthma

Abstract

In recent years, major developments have occurred in severe asthma management. Different asthma phenotypes and subgroups have been identified and new treatment options have become available. A total of five monoclonal antibodies are currently approved in severe asthma treatment: omalizumab, mepolizumab, reslizumab, benralizumab and dupilumab. These drugs have been shown to reduce exacerbations and to have an oral corticosteroid-sparing effect in many severe asthma patients. However, biological treatment is not successful in all patients and should be discontinued in non-responsive patients. Treating the right patient with the right biologic, and therefore biologic response prediction, has become a major point of interest in severe asthma management. A variety of response outcomes is utilized in the different clinical trials, as well as a huge range of potential predicting factors. Also, regarding the timing of the response evaluation, there are considerable differences between studies. This review summarizes the results from studies on predicting responses and responders to biological treatment in severe asthma, taking into account clinical, functional and inflammatory parameters assessed prior to the start of treatment as well as following a few months of therapy. In addition, future perspectives are discussed, highlighting the need for more research to improve patient identification and treatment responses in the field of biological treatment in severe asthma.

Treating severe asthma: Targeting the IL‐5 pathway

“…Understanding the impact of different asthma endotypes in treatment response may help physicians with choosing a personalized treatment, even if limited data are available for biomarkers prediction of treatment response to biologicals in severe asthma 78–80 . Especially for children, it is important to develop non‐invasive techniques to phenotype paediatric patients and guide treatment at an early phase.…”

“…Understanding the impact of different asthma endotypes in treatment response may help physicians with choosing a personalized treatment, even if limited data are available for biomarkers prediction of treatment response to biologicals in severe asthma. 78 , 79 , 80 Especially for children, it is important to develop non‐invasive techniques to phenotype paediatric patients and guide treatment at an early phase. New frontiers labelled as “omic s sciences” such as genomics, transcriptomics, proteomics, pharmacogenomics and metabolomics (which includes breathomics), are fascinating cutting‐edge technique that needs to be further explored in severe asthma, considered promising tools for the identification of novel predictive biomarkers related to good or poor response.…”

Eosinophils as Drivers of Severe Eosinophilic Asthma: Endotypes or Plasticity?

“…In spite of the progress allowed in SEA management, not all patients respond equally well to anti-eosinophil therapeutics. Further studies therefore aimed at determining which factors may influence the response to anti-eosinophil treatments [ 18 ]. Perhaps not surprisingly, given their targeting toward SEA, a history of frequent previous exacerbations and blood eosinophilia were consistently identified as good predictors of the response to all three anti-eosinophil therapeutics [ 22 , 23 , 30 , 70 , 71 , 72 , 73 , 74 , 75 ].…”

Aspirin‐exacerbated respiratory disease: personalized medical and surgical approaches

“…23 Similar questions have arisen in identifying responders and nonresponders in asthmatics, in whom biologics have been used for years. 24 These issues have become particularly important given the costs of biologics and the likelihood that there will be limitations upon which patients have access to these treatments. 25 Personalized or precision medicine for AERD/N-ERD patients has advanced dramatically in the last decade.…”