Advancements in biologic therapy in eosinophilic asthma

ABSTRACT

Introduction

Asthma encompasses a spectrum of phenotypes often categorized into two groups- type 2 high (T2 high) and type 2 low (T2 low). T2 high includes atopic and eosinophilic presentations whereas T2 low is non-atopic, non-eosinophilic, and oft associated with neutrophilic inflammation. Eosinophilic asthma is often driven by IgE, IL-4, IL-5, and IL-13 and TSLP. This can lead to eosinophilic inflammatory response in the airways which in turn can be used as target for treatment.

Areas covered

The article will focus on biologic therapy that is currently being used in eosinophilic asthma management in mainly the adult population including clinical trials and co-morbidities that can be treated using the same biologics. A review on asthma biologics for pediatric population has been reviewed elsewhere.

Expert opinion

Biological therapy for asthma targeting the IgE, IL-4, IL-5, IL-13, and TSLP pathways are shown to have benefit for the treatment of eosinophilic asthma, as exemplified in real-world studies. When choosing the right biological agent factors such as phenotype, comorbidities, and cost-effectiveness of the biologic agent must be taken into consideration.

KEYWORDS:

• Severe asthma
• eosinophil
• mepolizumab
• reslizumab
• omalizumab
• tezepelumab
• dupilumab
• benralizumab
• IL-5
• IgE
• IL-4
• IL-13
• TSLP

Article highlights

• Asthma is a heterogenous condition that affects roughly 315 million individuals globally.

• Eosinophilic asthma is driven by IgE, IL-4, IL-5, IL-13, and TSLP signaling pathways.

• Monoclonal antibodies have shown to be efficacious to treat eosinophilic asthma as exemplified in randomized placebo-controlled clinical trials and real-world studies.

• Biological therapy should be individualized after careful consideration of comorbidities, phenotypes, cost, and attainability of the drug.

Declaration of interest

TB Casale reports receiving honoraria from AstraZeneca, Novartis, Genentech, Regeneron, and Sanofi for work in advisory boards, steering committees, or giving educational lectures on asthma. JC Cardet reports receiving honoraria from AstraZeneca, Chiesi, GSK, Genentech, and Sanofi for work in advisory boards, steering committees, or giving educational lectures on asthma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14712598.2024.2342527

Additional information

Funding

This paper was funded by the Bristol Myers Squibb Foundation Winn Award and the ALA/AAAAI Allergic Respiratory Diseases Award [AI-835475]; awarded to JC Cardet.