Pragmatic Clinical Perspective on Biologics for Severe Refractory Type 2 Asthma.

The Journal of Allergy and Clinical Immunology. in Practice
Rory ChanBrian Lipworth

Abstract

Patients with severe refractory asthma present a challenging clinical conundrum for practicing clinicians. Biologics that target key mediators in the type 2 inflammation cascade, including IL-4, IL-5, IL-13, and IgE, can be effective strategies for these patients. However, with various biologics available, choosing the optimal one for a particular patient becomes a nuanced decision. We propose a pragmatic algorithm that identifies the optimal biologic class for patients who have specific type 2 disease endotypes. Patients with eosinophilic endotypes fare well with anti-IL-5(rα) medications, comprising mepolizumab, benralizumab, and reslizumab because they have been shown to reduce exacerbations in severe eosinophilic asthma by approximately 50%. In patients with fractional exhaled nitric oxide-high endotypes, anti-IL-4rα such as dupilumab is deemed to be most effective and has demonstrated a 47% reduction in asthma exacerbations. For patients with severe uncontrolled allergic asthma, anti-IgE (omalizumab) is effective and has been shown to confer a 25% reduction in asthma exacerbations. Type 2 comorbidities including chronic rhinosinusitis with nasal polyps, atopic dermatitis, chronic idiopathic urticaria, and eosinophilic esop...Continue Reading

Citations

Feb 6, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Rory ChanBrian Lipworth
May 14, 2021·Biologics : Targets & Therapy·Martina VottoGian Luigi Marseglia
Jun 22, 2021·Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology·Rory Chan, Brian Lipworth
Aug 1, 2021·The Journal of Allergy and Clinical Immunology. in Practice·Brian J Lipworth, Rory Chan

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