CHEST Guidelines-Anti-IL-5-for-Severe-Asthma

Anti-IL-5-for-Severe-Asthma_chest

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The article discusses advances in treatments for severe asthma, particularly targeting type 2-mediated immunity and eosinophilic inflammation, which are key factors behind asthma exacerbations. Asthma affects around 300 million individuals globally, with 10% experiencing severe forms. Traditional treatments have focused on corticosteroids and anti-immunoglobulin E, but newer therapies aim at further reducing inflammation through targeting interleukins and specific receptors, such as IL-4Ra, IL-5, IL-5R, IL-13, and the type 2 prostaglandin D2 receptor.<br /><br />IL-5 is highlighted as an important target because it is crucial for the maturation and survival of eosinophils, cells that can exacerbate asthma when they cause persistent inflammation. Anti-IL-5 therapies, such as mepolizumab and reslizumab, and the anti-IL-5R biologic benralizumab, have shown promising results in phase III trials by reducing severe asthma exacerbations. However, while they consistently decrease exacerbations, they yield varying outcomes regarding improvements in lung function and overall asthma control. More substantial effects on lung function were seen in studies with reslizumab and benralizumab compared to mepolizumab.<br /><br />The studies stress the need for effective biomarkers to help predict clinical responses to these therapies. Elevated blood eosinophil counts are particularly associated with positive treatment outcomes. Despite noted benefits of these therapies, the challenge remains in determining the appropriate blood eosinophil count levels for the best therapeutic outcomes.<br /><br />Future therapy selections may be informed by a deeper understanding of the underlying immune mechanisms and precise biomarkers indicating specific asthma phenotypes. Emerging therapies like dupilumab, which targets both IL-4 and IL-13, and small molecules like fevipiprant, show promise and might offer broader anti-inflammatory effects, marking a new era in precision medicine for asthma care.

Keywords

severe asthma

type 2 immunity

eosinophilic inflammation

interleukin targeting

IL-5 therapies

mepolizumab

reslizumab

biomarkers

dupilumab

precision medicine