Personalized medicine with biologics for severe type 2 asthma: current status and future prospects

Godar, Marie; Blanchetot, Christophe; Haard, Hans de; Lambrecht, Bart N.; Brusselle, Guy

doi:10.1080/19420862.2017.1392425

Cited by 73 publications

(67 citation statements)

References 72 publications

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“…Similar to adults, children with severe asthma likely encompass a broad immune spectrum. Nonetheless, expression of the same cytokine across multiple T cell types and subtypes can be exploited by specific therapies (Figure ) . Several monoclonal antibodies are in clinical use that target type 2 responses and reduce asthma exacerbations in adults with moderate‐to‐severe Th2‐high/eosinophilic disease.…”

Section: Future Research Directions and Clinical Implicationsmentioning

confidence: 99%

T cells in severe childhood asthma

Paul

Muehling

Eccles

et al. 2019

Clin Experimental Allergy

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Summary Severe asthma in children is a debilitating condition that accounts for a disproportionately large health and economic burden of asthma. Reasons for the lack of a response to standard anti‐inflammatory therapies remain enigmatic. Work in the last decade has shed new light on the heterogeneous nature of asthma, and the varied immunopathologies of severe disease, which are leading to new treatment approaches for the individual patient. However, most studies to date that explored the immune landscape of the inflamed lower airways have focused on adults. T cells are pivotal to the inception and persistence of inflammatory processes in the diseased lungs, despite a contemporary shift in focus to immune events at the epithelial barrier. This article outlines current knowledge on the types of T cells and related cell types that are implicated in severe asthma. The potential for environmental exposures and other inflammatory cues to condition the immune environment of the lung in early life to favour pathogenic T cells and steroid resistance is discussed. The contributions of T cells and their cytokines to inflammatory processes and treatment resistance are also considered, with an emphasis on new observations in children that argue against conventional type 1 and type 2 T cell paradigms. Finally, the ability for new technologies to revolutionize our understanding of T cells in severe childhood asthma, and to guide future treatment strategies that could mitigate this disease, is highlighted.

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Section: Future Research Directions and Clinical Implicationsmentioning

confidence: 99%

T cells in severe childhood asthma

Paul

Muehling

Eccles

et al. 2019

Clin Experimental Allergy

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“…Közöttük halmozódik a kórházi bent fekvések és a táppénzes napok száma, a munkából való kiesés, az asztma miatti munkaképesség-csökkenés, és gyakori a szisztémás szteroidok miatti mellékhatás (Csoma et al, 2011;Chung et al, 2013). A patogenetikában azonosított molekuláris útvonalakban több gyógyszercélpontot azonosítottak, melyekre sikerült megfelelő biológiai szereket kifejleszteni (Godar et al, 2018). A főbb hatóanyagokat a 2. ábra foglalja össze.…”

Section: A Patogenezisben Felderített Terápiás Célpontok Terápiás Leunclassified

Az asthma bronchiale és biológiai kezelése

Horváth¹,

Csoma²,

Kovács³

2019

Ma.Tud.

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2 az MTA doktora, egyetemi tanár, orvosigazgató, igazgatosag@koranyi.hu 3 PhD, járóbeteg-ellátást vezető főorvos 4 főigazgató főorvos, igazgatosag@koranyi.hu ÖSSZEFOGLALÁS Az asztma közel 350 millió embert érint a világon, a legnagyobb kihívást a betegek 5-10%-át érintő súlyos asztma jelenti. A biológiai gyógyszereknek a fejlesztése ezen a területen hozott áttörő eredményeket. Súlyos allergiás asztmában évek óta használatban van az immunglobulin E elleni antitest, és a súlyos eozinofilsejtes asztmában ma már több molekula is elérhető, amelyek a 2. típusú immunitás citokinjeit vagy azok receptorát támadják. Ezek a gyógyszerek csökkentve állapotrosszabbodásaik számát és szisztémás szteroid igényüket, hatékonyan javítják a betegek állapotát. A súlyos asztma kezelése így egyre inkább személyre szabható. A jelen összefoglalóban a szerzők áttekintik a súlyos asztma kezelésében használt biológiai szereket és a terület új fejlesztési irányait. ABSTRACTAsthma affects almost 350 million people worldwide, the disease burden is the highest in that 5-10% of asthmatics who suffer from severe asthma. Biological treatment options have gained position in this severely affected patient group. Their development has occurred together with better understanding of the pathomechanism and the development of biomarkers for disease phenotyping. These improvements led to new drugs available for the treatment of severe allergic asthma and severe eozinofilic asthma. Monoclonal antibodies against different pathways has led to improvement in disease control by decreasing the number of asthma exacerbations and resulting in decreased need for systemic steroids. This approaches have paved the way for more personalised treatment approach in this disease. We review the currently available biologics for severe asthma together with the new developments.

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“…To better understand and treat the extensive heterogeneity of asthma, many expert groups have proposed distinctive classifications of SA (7)(8)(9)(10)(11), with the goal of advancing research and treatment paradigms toward precision medicine. In recent years, much research has led to the identification of SA phenotypes wherein specific biological pathways and mechanisms (endotypes) are being identified to explain the observable properties of the phenotypes, and improving the future prospects for these difficult-to-treat patients (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Severe asthma and eligibility for biologics in a Brazilian cohort

et al. 2020

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Objective: This study aims to describe the eligibility for biologic therapies for severe asthma (SA) in a cohort of patients attending the Program for Control of Asthma (ProAR) in Bahia, Brazil. Methods: Data from SA patients (!18 years old) attending the ProAR, that were included in a case-control study conducted from 2013 to 2015, were used to reassess patients according to a modified ERS/ATS 2014 SA criteria. Patients were then classified according to the eligibility for SA biological therapy based on current prescription labels. Results: From 544 patients in the cohort, 531 (97.6%) were included and 172 (32.4%) were identified as SA patients according to the ERS/ATS 2014 modified criteria. Of these 172 patients, 69 (40.1%) were ineligible for any of the biologicals approved for asthma (omalizumab, mepolizumab, reslizumab and benralizumab), 60 (34.9%) patients were eligible for one of the biological therapies, and 10 (5.8%) patients were eligible for all biological therapies. Conclusions: More than half of patients with SA were eligible for biologic therapy in our study, but none of them received this form of treatment. Almost half of them were not eligible to any of the approved biologics, however. The variability and overlap in patients' eligibility highlight the importance of evaluating each patient individually for a more personalized treatment approach. While there is a need to increase access for some of those eligible that may really need a biologic treatment, continuous efforts are required to develop alternatives to those who are not eligible.

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Personalized medicine with biologics for severe type 2 asthma: current status and future prospects

Cited by 73 publications

References 72 publications

T cells in severe childhood asthma

T cells in severe childhood asthma

Az asthma bronchiale és biológiai kezelése

Severe asthma and eligibility for biologics in a Brazilian cohort

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