Care pathways for the selection of a biologic in severe asthma

Bousquet, Jean; Brusselle, Guy; Buhl, Roland; Busse, William W.; Cruz, Álvaro A.; Djukanović, Ratko; Domingo, Christian; Hanania, Nicola A.; Humbert, Marc; Gow, Andrew; Phipatanakul, Wanda; Wahn, Ulrich; Wechsler, Michael E.

doi:10.1183/13993003.01782-2017

Cited by 83 publications

(83 citation statements)

References 33 publications

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“…In patients with characteristics from both sub‐endotypes showing an allergic/eosinophilic overlap, either anti‐IgE or an anti‐IL‐5/5Ra could be a possible choice. Anti‐IgE has been shown efficient even in patients with blood eosinophils ≥ 300/µL at 16 weeks and has a documented long time safety profile, even during pregnancy There is a documented strategy for evaluating the effectiveness of anti‐IgE therapy after 16 weeks, while responsive data for an anti‐IL‐5/5Ra treatment are still lacking . As anti‐IL‐5 treatment can be effective in patients that have been previously treated with anti‐IgE, evaluation of therapeutic efficacy of anti‐IgE after 16 weeks seems to be reasonable to decide if the patient should continue or switch to anti‐IL‐5/IL‐5Ra .…”

Section: Asthmamentioning

confidence: 99%

New biological treatments for asthma and skin allergies

Eyerich

Metz

Bossios

et al. 2019

Allergy

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Allergies are typically endemic, complex and heterogeneous diseases with a high impact at quality of life. Mechanistically, type 2 immune responses involving eosinophil and basophil granulocytes, mast cells and humoral factors such as IgE are key drivers of allergic diseases. Fighting allergic diseases knows three strategies: prevention, symptomatic and causative therapy. While remarkable progress was made in understanding molecular events in allergies as a prerequisite for effective prevention and desensitization, this review article focuses on the most efficient symptomatic treatments—that is using more and more specific antibodies neutralizing particular immune pathways. We highlight and classify recent and upcoming developments in the three prototype chronic allergic diseases allergic asthma, chronic spontaneous urticaria and atopic eczema. In all three examples, biologics such as dupilumab or omalizumab become reliable and efficient therapeutic options. Finally, we give an outlook how a diagnostic and therapeutic workflow might look like in the near future for these three major burdens of society.

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Section: Asthmamentioning

confidence: 99%

New biological treatments for asthma and skin allergies

Eyerich

Metz

Bossios

et al. 2019

Allergy

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“…A potential barrier to adaptation is the need for better biomarkers guiding the choice of treatment in the individual patient: valid biomarkers exist for the 2 types of monoclonal antibodies that are approved for therapeutic use: blood eosinophilia and sputum eosinophilia predict effect of anti‐IL5 in patients with exacerbations, and FeNO predicts the effect of anti‐IgE . However, at present, there is no clear indication of when to choose anti‐IL5 or anti‐IgE in a patient with severe, eosinophilic, allergic asthma, although an algorithm for treatment decisions was recently proposed . Moreover, with the expected advent of monoclonal antibodies targeting the IL‐4/13 pathway, or upstream in the IL‐33 or anti‐TSLP pathway, there will be an increasing need for guidance between treatments.…”

Section: Clinical Adaptation Of Novel Treatments For Oad: Barriers Anmentioning

confidence: 99%

“…88 However, at present, there is no clear indication of when to choose anti-IL5 or anti-IgE in a patient with severe, eosinophilic, allergic asthma, although an algorithm for treatment decisions was recently proposed. 89 Moreover, with the expected advent of monoclonal antibodies targeting the IL-4/13 pathway, or upstream in the IL-33 or anti-TSLP pathway, there will be an increasing need for guidance between treatments.…”

mentioning

confidence: 99%

Advancing the management of obstructive airways diseases through translational research

Porsbjerg

Sverrild

Baines

et al. 2018

Clin Experimental Allergy

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Obstructive airways diseases (OAD) represent a huge burden of illness world-wide, and in spite of the development of effective therapies, significant morbidity and mortality related to asthma and COPD still remains. Over the past decade, our understanding of OAD has improved vastly, and novel treatments have evolved. This evolution is the result of successful translational research, which has connected clinical presentations of OAD and underlying disease mechanisms, thereby enabling the development of targeted treatments. The next challenge of translational research will be to position these novel treatments for OAD for optimal clinical use. At the same time, there is great potential in these treatments providing even better insights into disease mechanisms in OAD by studying the effects of blocking individual immunological pathways. To optimize this potential, there is a need to ensure that translational aspects are added to randomized clinical trials, as well as real-world studies, but also to use other trial designs such as platform studies, which allow for simultaneous assessment of different interventions. Furthermore, demonstrating clinical impact, that is research translation, is an increasingly important component of successful translational research. This review outlines concepts of translational research, exemplifying how translational research has moved management of obstructive airways diseases into the next century, with the introduction of targeted, individualized therapy. Furthermore, the review describes how these therapies may be used as research tools to further our understanding of disease mechanisms in OAD, through translational, mechanistic studies. We underline the current need for implementing basic immunological concepts into clinical care in order to optimize the use of novel targeted treatments and to further the clinical understanding of disease mechanisms. Finally, potential barriers to adoption of novel targeted therapies into routine practice and how these may be overcome are described.

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“…Grund dafür ist das Risiko kortisonbedingter Zusatzerkrankungen. Bei der Auswahl einer Biologika-Therapie für Patienten mit schwerem Asthma könnte sich der in Abbildung 1 dargestellte Behandlungspfad «Inte grated Care Path ways» aus dem Jahr 2017 als hilfreich erweisen [2]. [7].…”

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“…Bei schwerbetroffenen Allergieasthmatikern empfiehlt der Behandlungspfad daher unabhängig von der Eosinophilenzahl zunächst die Indikation für Omalizumab. Erst wenn sich das Anti-IgE-Bio logikum als keine Therapieoption erweist, sollte die Gabe von Anti-IL-5 geprüft werden [2].…”

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Phänotypisierung bei schwerem Asthma bronchiale: Die richtigen Medikamente für die richtigen Lungen

2018

Karger Kompass Pneumol

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Care pathways for the selection of a biologic in severe asthma

Cited by 83 publications

References 33 publications

New biological treatments for asthma and skin allergies

New biological treatments for asthma and skin allergies

Advancing the management of obstructive airways diseases through translational research

Phänotypisierung bei schwerem Asthma bronchiale: Die richtigen Medikamente für die richtigen Lungen

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