Efficacy and safety of reslizumab in patients with moderate to severe eosinophilic asthma

Abstract

Reslizumab, a neutralizing anti-IL-5 monoclonal antibody, is a promising adjunctive treatment for severe eosinophilic asthma. Monthly intravenous 3.0 mg/kg reslizumab had resulted in improvements in lung function and asthma control. It is well tolerated and common adverse events include headache, nasopharyngitis and upper respiratory tract infection. Rebound eosinophilia after cessation of reslizumab and attenuation of the treatment response with repeated dosing had been reported. Stringent selection of patients with a high eosinophil burden, who are poorly controlled despite moderate to high doses of inhaled corticosteroid, confers the most significant treatment response. Future trials should compare the dose, delivery platform, frequency of dosing and study combinations with other biologics, which will affect its maximal clinical efficacy.

Keywords:

• eosinophilic asthma
• IL-5
• monoclonal antibody
• reslizumab
• sputum cell counts

Financial & competing interests disclosure

H Lim was supported by an Academic Medicine Development Award from the National University Health System. P Nair is supported by a Canada Research Chair in Airway Inflammometry. H Lim has 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. P Nair has received honoraria from Teva, Roche, GSK, AZ, Sanofi, Novartis and Merck and is listed on a patent for a biological filtration device.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Reslizumab, an anti-IL 5 monoclonal antibody that suppresses eosinophilic activity, is a useful and safe adjunctive treatment for severe eosinophilic asthma.

• Monthly intravenous reslizumab at a dose of 3.0 mg/kg had been shown to result in improvements in forced expiratory volume in the first second and asthma control questionnaire.

• It is well tolerated generally; common mild adverse side effects include headache, nasopharyngitis and upper respiratory tract infection.

• Rebound eosinophilia and attenuation of repeated dosing had been reported but is not well understood.

• To extract the maximal clinical response, it is crucial to target patients with high eosinophilic burden, that is, high blood and sputum eosinophil and/or nasal polyposis.

• Sputum examination may also be a useful monitoring tool during treatment, to predict, characterize and guide treatment for asthma exacerbations.

• Its biological activity is largely similar to the other monoclonal antibody and the differences may be related to the dose, delivery platform and dosing frequency.

• Anti-IL-5 monoclonal antibody treatment should be reserved for the patients who have high eosinophilic burden, recurrent exacerbations and who remain poorly controlled despite compliance to high doses of corticosteroid and optimization in accordance with usual guidelines.

• Future long-term trials should attempt to answer the questions: what is the optimal dosing regimen, the long-term safety and combined therapeutic effect with other biologics.