CHEST Guidelines--strong-COUNTERPOINT---strong--Will-New-Anti-eosin

-strong-COUNTERPOINT---strong--Will-New-Anti-eosin

Pdf Summary

The document discusses the efficacy and implications of anti-eosinophilic therapies, particularly Anti-IL-5 therapies, in managing severe asthma. Severe asthma exacerbations pose significant risks to patients, create stress for caregivers, and incur substantial healthcare costs, justifying the use of costly biologic treatments that may reduce exacerbations and decrease reliance on oral corticosteroids.<br /><br />Anti-IL-5 therapies, such as mepolizumab and reslizumab, have been approved in many regions for treating severe refractory eosinophilic asthma due to their demonstrated ability to lower exacerbation rates. However, they offer limited improvement concerning symptoms, lung function, or quality of life, and their use is limited to patients with specific asthma phenotypes. Notably, even with significant eosinophil reduction, these therapies do not eliminate exacerbations, likely because they do not address mast cell activation contributing to daily asthma symptoms. Moreover, not all patients with severe asthma—especially those lacking persistent airway eosinophilia—derive benefit from these treatments.<br /><br />The document also highlights the broader challenge of asthma management, where poor control is often attributed to non-adherence to effective inhaled corticosteroid therapy. Anti-eosinophilic drugs may only benefit a minority, mainly due to their high cost and the nature of severe asthma cases. Alternatives, such as corticosteroid-containing reliever medications or electronic monitoring to improve adherence, could present more cost-effective solutions.<br /><br />Although these treatments may mark progress in precision medicine, their impact is limited due to eosinophilic inflammation's responsiveness to corticosteroids and significant efficacy concerns. For countries with high asthma prevalence, the cost and targeted nature of anti-eosinophilic therapies may restrict their widespread application, despite offering significant benefits to a small fraction of patients with severe refractory eosinophilic asthma.

Keywords

anti-eosinophilic therapies

Anti-IL-5 therapies

severe asthma

mepolizumab

reslizumab

eosinophilic asthma

biologic treatments

corticosteroids

asthma management

precision medicine