Prediction for Success of Biologics in Severe Asthma

The management of Severe Asthma has been revolutionised recently by the advent of biologics or monoclonal antibodies targeting specific mediators of asthma. These are now routinely used in many countries around the world as part of treatment protocols. However they are expensive, so it is important to ensure that the right drug is given to the right patient. So, how do you know whether prescribing the patients will be beneficial?

Around 5–10% of the total asthmatic population suffers from severe or uncontrolled asthma, which is associated with increased mortality, hospitalization, an increased healthcare burden and a worse quality of life. Over the last few years though, therapy with biologics has changed the management of these cases in adults and adolescents. These medications are mostly directed against molecules involved in type 2 inflammatory pathways, and as a result, reduce airway inflammation.

To date, five biologic molecules have been officially approved for use in selected severe asthmatic patients in most countries. Omalizumab is an anti-IgE monoclonal antibody. Three more biologics belong to a different class. These are Mepolizumab, reslizumab and benralizumab. They all target the interleukin-5 (IL-5) pathway. And finally, dupilumab works against the interleukin-4 (IL-4) receptor, blocking the signalling pathways of IL-4 and IL-13. The major challenge of biologics remains the prediction of success in severe asthma, and the choice of the right biologic for the right patient.

Learn more from Prof. Milos Jesenak, EUFOREA asthma expert panel member and Professor of Paediatrics at the Jessenius Faculty of Medicine, Comenius University in Slovakia, and Prof. Vibeke Backer, EUFOREA asthma expert panel member and Chief Respiratory Physician in the Department of ENT and the Centre for Physical Activity Research at Rigshospitalet, in Copenhagen, in Denmark.