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Biologic agents for severe asthma patients: clinical perspectives and implications

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Abstract

Asthma is a chronic inflammatory multifactorial disorder of the airways characterized by the involvement of immune cells and mediators in its onset and maintenance. Traditional therapeutic strategies have been unsatisfactory in controlling the underlying pathology, especially in the more severe states. Hence in the last couple of decades, new biological approaches targeting molecular mediators have been developed. In this narrative review we examine biological agents currently available for the management of severe asthma, focusing our attention on their clinical application, pros and cons, and in particular on gaps regarding the use of these agents. The most well-known and used biologic agent in clinical practice is omalizumab, though there is emerging evidence for mepolizumab too. The future of these biological therapies is to broaden our knowledge of their practical use and ascertain predictive biomarkers, or define an algorithm, useful in the optimal application of these ‘biological weapons’.

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Abbreviations

AQLQ:

Asthma Quality of Life Questionnaire

ACQ:

Asthma Control Questionnaire

BHR:

Bronchial hyper-responsiveness

DBPC:

Double blind placebo controlled

EMA:

European Medicine Agency

FDA:

Food and Drug Administration

FEV1 :

Forced expiratory volume in the 1ts second

GETE:

Global evaluation of treatment effectiveness

ICS:

Inhaled corticosteroids

LABA:

Long-acting b2-adrenoceptor agonists

mAb:

Monoclonal antibody

OCS:

Oral corticosteroids

QoL:

Quality of life

RCTs:

Randomized controlled trials

SGRQ:

St. George’s Respiratory Questionnaire

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  1. Massimo Caruso and Jaymin Morjaria contributed equally to manuscript.

Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, A.O.U. Policlinico – Vittorio Emanuele, Università degli Studi di Catania, Via S. Sofia, 78, 95123, Catania, Italy

    Massimo Caruso, Rosalia Emma & Riccardo Polosa

  2. Royal Brompton and Harefield Hospital NHS Trust, London, UK

    Jaymin Morjaria

  3. Department of Internal and Emergency Medicine, AOU “Policlinico – Vittorio Emanuele”, Catania, Italy

    Maria Domenica Amaradio & Riccardo Polosa

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  1. Massimo Caruso
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  2. Jaymin Morjaria
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  3. Rosalia Emma
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  4. Maria Domenica Amaradio
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  5. Riccardo Polosa
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Correspondence to Massimo Caruso.

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Caruso, M., Morjaria, J., Emma, R. et al. Biologic agents for severe asthma patients: clinical perspectives and implications. Intern Emerg Med 13, 155–176 (2018). https://doi.org/10.1007/s11739-017-1773-y

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