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Stratified medicine in selecting biologics for the treatment of severe asthma

Morjaria, Jaymin B; Proiti, Maria; Polosa, Riccardo

Current Opinion in Allergy & Clinical Immunology: February 2011 - Volume 11 - Issue 1 - p 58–63
doi: 10.1097/ACI.0b013e3283423245
Mechanisms of allergy and adult asthma: Edited by Stephen T. Holgate and J. Andrew Grant

Purpose of review: Despite optimal treatment, asthma symptoms in about 5–10% of patients remain poorly controlled. Apart from having an impact on their asthma-related quality of life and adverse effects of the medications used (especially corticosteroids), their severe symptoms also impact healthcare resources due to frequent admission and requirement for intensive medications use. The last decade has seen an improved understanding in the pathophysiology of the complex cellular and molecular networks involved in the inflammatory and immunological phenotype of severe asthma. This knowledge may help providing strategies by which these phenotypes operate and pave the way for drug development and individualized treatment.

Recent findings: Here we review the current evidence of biological agents in patients with severe asthma recently assessed for safety and efficacy. Some of these agents have shown to be useful in specifically targeted subpopulations of patients with severe asthma, whereas others have proven to be unsafe and/or unsuccessful. In addition, we discuss recent data on clinical and pharmacokinetic–pharmacodynamic aspects of omalizumab, the only licensed anti-IgE therapy for severe atopic asthma.

Summary: More basic science work is required to improve the current understanding of severe asthma pathophysiology and proof-of-concept clinical studies are required to explore relevant biomolecular targets in this small subset of patients. At present, only one drug is licensed for allergic asthmatic patients with severe disease, omalizumab. Novel therapies in the form of oligonucleotide therapies and other biological agents are also being investigated in the difficult-to-treat asthmatic patient group.

aIIR Division, School of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK

bInstitute of Internal Medicine, S. Marta Hospital, Azienda Ospedaliero-Universitaria ‘Policlinico-Vittorio Emanuele’, Università di Catania, Catania, Italy

Correspondence to Dr Jaymin B. Morjaria, IIR Division, School of Medicine, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK Tel: +44 2380796891; fax: +44 2380701771

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.