CHEST Guidelines-POINT--Will-New-Anti-eosinophilic-Drugs-Be-Useful-

POINT--Will-New-Anti-eosinophilic-Drugs-Be-Useful-

Pdf Summary

The editorial discusses the role of new anti-eosinophilic drugs in managing asthma, highlighting both support and skepticism for their use. Paul M. O’Byrne argues in favor of these drugs, emphasizing that while inhaled corticosteroids (ICS) remain the cornerstone of asthma management, not all patients achieve control, particularly those with severe refractory asthma. In this subset of patients, traditional treatments like ICS and long-acting β2-agonists often fall short. Until recently, treatment options included oral corticosteroids and anti-IgE humanized monoclonal antibodies (hMab) like omalizumab, specifically for severe refractory allergic asthma.<br /><br />O’Byrne notes that new biologics targeting cytokines such as IL-5 have shown promise. Drugs like mepolizumab and reslizumab, both targeting IL-5, and benralizumab, targeting the IL-5 receptor, have demonstrated significant reductions in asthma exacerbations and improvements in lung function, particularly in eosinophilic asthma phenotypes. These advancements allow for a decrease or discontinuation of oral corticosteroids, reducing associated side effects.<br /><br />Additionally, the editorial mentions other beneficial humanized monoclonal antibodies targeting IL-4 and IL-13, like dupilumab, which show potential in reducing asthma exacerbations and improving pulmonary function.<br /><br />Despite these optimistic findings, there are concerns raised by Peter J. Barnes, who questions the long-term utility and cost-effectiveness of these biologics in asthma treatment. He argues that response is not uniform across all patients, and many do not have persistent airway eosinophilia. Furthermore, the high cost of biologics raises issues about widespread adoption, especially considering that for some patient groups, existing treatments may suffice.<br /><br />In summary, while anti-eosinophilic drugs represent a significant advancement for asthma patients unresponsive to traditional therapies, careful consideration of patient phenotype and cost-effectiveness is crucial. The decision to incorporate these drugs into routine asthma management should be weighed against the individual patient's clinical profile and healthcare resources.

Keywords

anti-eosinophilic drugs

asthma management

inhaled corticosteroids

severe refractory asthma

mepolizumab

reslizumab

benralizumab

monoclonal antibodies

cytokines

cost-effectiveness