Omalizumab and mepolizumab in the landscape of biological therapy for severe asthma in children: how to choose?

Abstract

Severe asthma has a substantial epidemiological impact on children and biological treatments can be an option to take into account, as they target specific molecules and pathways involved in its pathogenesis. Modern medicine is continuously and progressively oriented towards tailored treatments designed specifically for the pathology patterns observed in individual patients and identified as endotypes with associated biomarkers. In this regard, biologic treatments in asthma are one of the best examples. Among the biological drugs currently available, omalizumab is the one with the greatest amount of data on efficacy and safety, and the one we have more real-life clinical experience with. However, mepolizumab will likely be accessible soon globally for clinical use. Moreover, research on biological drugs for the treatment of severe asthma is expanding rapidly, with some molecules currently used in adult patients that could be registered also for pediatric use and new molecules that could be available in the future. On the other hand, due to this potential abundance of therapeutic options, new criteria could become necessary to guide clinicians through an evidence-based choice between omalizumab and these new drugs. For the same reason, more data collected specifically from pediatric clinical trials are necessary. In this review we aim to analyze the factors that could help clinicians make their choice and to highlight the unmet need for a more evidence-based choice.

Biologic Treatments for Asthma and Chronic Obstructive Pulmonary Disorder

“…As a result, eosinophil maturation is disabled in the bone marrow and eosinophil levels are decreased in blood and bronchial mucus [70]. However, as mepolizumab is highly effective at neutralizing IL-5, immune pathways crucial to antiparasitic response may be compromised, a side effect that must be taken into account within developing countries or pediatric patients [71].…”

Keeping Pace with Adolescent Asthma: A Practical Approach to Optimizing Care

“…Omalizumab has nevertheless been proven to be safe and well tolerated in children [ 53 ], even with treatment duration beyond 2 years [ 54 ]. Mepolizumab (targets interleukin-5) and dupilumab (antibody to interleukin-4) were more recently approved for children with refractory eosinophilic asthma [ 55 ].…”

Best practices, challenges and innovations in pediatrics in 2019

“…Precision medicine targets the mechanisms (endotypes) of allergic diseases. In asthma, the precision approach is based on monoclonal antibodies [ 11 ] and allergen specific immunotherapy [ 12 ]. Giovannini et al [ 11 ] compared omalizumab and mepolizumab.…”

“…In asthma, the precision approach is based on monoclonal antibodies [ 11 ] and allergen specific immunotherapy [ 12 ]. Giovannini et al [ 11 ] compared omalizumab and mepolizumab. They are monoclonal antibodies used in type 2-high asthma [ 13 ].…”

“…Omalizumab is a humanized monoclonal IgG antibody binding the circulating IgE for children with moderate - severe persistent allergic asthma to perennial aeroallergens that is not controlled with inhaled corticosteroids and long-acting inhaled β2-agonist. It is useful also when seasonal pollens [ 14 ] induce exacerbations [ 11 ]. Mepolizumab is a humanized monoclonal IgG antibody binding IL-5 for add-on treatment in asthmatics with elevated blood eosinophils count.…”