Figures & data
Figure 1. GINA stepwise asthma treatmentCitation6.
Asthma management requires assessment of current symptoms, adjustment of treatment accordingly and review of the response; assessment should be repeated periodically to ensure optimal treatment. GINA asthma treatment is separated into five steps, with increasing step number corresponding to increasing level of intervention.
Abbreviations. FEV1, Forced expiratory volume in 1 s; GINA, Global Initiative for Asthma; HDM, House dust mite; ICS, Inhaled corticosteroid; IgE, Immunoglobulin-E; IL, Interleukin; LABA, Long-acting β2-agonist; LTRA, Leukotriene receptor antagonist; OCS, Oral corticosteroid; SABA, Short-acting β2-agonist; SLIT, Sublingual immunotherapy. *Not for children <12 years. **For children 6 to 11 years, the preferred Step 3 treatment is medium-dose ICS. †Tiotropium by mist inhaler is an add-on treatment for patients with a history of exacerbations; it is not indicated in children <12 years of age.
From Global Initiative for Asthma (GINA), ‘Global Strategy for Asthma Management and Prevention,’ (2017). Reprinted with permission from GINA, http://ginasthma.org/2017-gina-report-global-strategy-for-asthma-management-and-prevention/
Table 1. Clinical profile of late-onset eosinophilic asthmaCitation23.
Figure 2. Mechanistic differences between mepolizumab/reslizumab and benralizumabCitation76. (A) Mepolizumab and reslizumab are monoclonal antibodies against IL-5 that prevent the binding of IL-5 to the receptor, resulting in eosinophil depletion. (B) Benralizumab is a humanized, afucosylated monoclonal antibody that binds to the α subunit of the IL-5 receptor. The absence of fucose on the Fc domain of benralizumab facilitates binding to FcgRIIIa receptors on NKs, leading to apoptosis of eosinophils (and basophils) through ADCC. The apoptosis of eosinophils does not result in the release of granule contentCitation95. Abbreviations. ADCC, Antibody-dependent cell-mediated cytotoxicity; FcgRIIIa, Low affinity immunoglobulin-γ Fc region receptor III-α; IL, Interleukin; NK, Natural killer cell.
Republished with permission from Dove Medical Press Limited, from ‘Benralizumab: a unique IL-5 inhibitor for severe asthma,’ by Tan, Bratt, Godor, et al; Journal of Asthma and Allergy, 2016:9 71-81.
Figure 3. Findings from key anti-IL-5 and anti-eosinophil studies. Phase 3 trial top-line results for anti-IL-5 and anti-eosinophil agents are summarized.
Abbreviations. ACQ-5, Asthma Control Questionnaire-5; AHR, Airway hyperresponsiveness; DB, Double-blind; EOS, Eosinophil count; FEV1, Forced expiratory volume in 1 s; ICS, Inhaled corticosteroid; IL, Interleukin; IV, Intravenous; LABA, Long-acting β2-agonist; OCS, Oral corticosteroid; PC, Placebo-controlled; PG, Parallel-group; Q2W, Administered every 2 weeks; Q4W, Administered every 4 weeks; Q8W, Administered every 8 weeks; SC, Subcutaneous.
