Overview of biologic therapies for severe asthma
| Biologic therapy | Approval year | Targets | Indication | Mechanism of action | Age range | Clinical outcomes | Trials/Studies | Dosage | References |
|---|---|---|---|---|---|---|---|---|---|
| Omalizumab | 2003 | IgE | Severe asthma, allergic asthma | - Prevents IgE binding to FcεRI- Inhibits mast cell IgE receptor expression | ≥ 6 years old | - Reduces exacerbations- Improves asthma control- Reduces hospitalization risk- Allows ICS dose reduction | - Clinical trials: GAIN, EXTRA, and others- Review of 25 trials (2014) | - Based on age and total IgE levels | [32, 115, 116, 119] |
| Mepolizumab | 2015 | IL-5 | Severe asthma with eosinophilic phenotype | - Prevents IL-5 from binding to IL-5Rα | ≥ 6 years old | - Reduces exacerbations by 53%- Improves quality of life and symptom control- Increases FEV1 | - Trials: DREAM, SIRIUS, MUSCA, MENSA | - 100 mg every 4 weeks | [58, 133, 134] |
| Benralizumab | 2017 | IL-5Rα | Severe asthma with eosinophilic phenotype | - Prevents IL-5 from acting on eosinophils- Induces eosinophil apoptosis | ≥ 12 years old | - Decreases exacerbation rates- Reduces OCS use- Improves asthma symptoms- Enhances quality of life and lung function | - Trials: ZONDA, SIROCCO, ANDHI, CALIMA | - 30 mg every 4 weeks for 3 doses- Then every 8 weeks | [135, 136] |
| Reslizumab | 2016 | IL-5 | Severe eosinophilic asthma | - Prevents IL-5 from binding to IL-5Rα | ≥ 18 years old | - Improves FEV1- Reduces exacerbations- Decreases eosinophil count- Improves quality of life | - Trials: RESPIRE 1 and 2, and others | - 3 mg/kg every 4 weeks | [58, 123] |
| Dupilumab | 2018 | IL-4Rα | Severe asthma, eosinophilic phenotype or OCS-dependent asthma | - Blocks IL-4 and IL-13 from binding to IL-4Rα | ≥ 6 years old | - Improves asthma control- Enhances lung function- Reduces exacerbations and OCS use | - Trials: LIBERTY ASTHMA QUEST, VENTURE, and others | - Dosage not specified | [120, 122, 124, 129, 130] |
| Tezepelumab | 2021 | TSLP | Severe asthma | - Blocks TSLP from interacting with its receptor | ≥ 12 years old | - Decreases exacerbation rates- Increases FEV1- Improves quality of life- Reduces OCS dose | - Trials: PATHWAY, NAVIGATOR, SOURCE, DESTINATION | - 210 mg every 4 weeks | [78, 85, 139–141] |
IgE: immunoglobulin E; FcεRI: high-affinity immunoglobulin E receptor; ICS: inhaled corticosteroids; IL: IL: interleukin; FEV1: forced expiratory volume in 1 second; OCS: oral corticosteroid; TSLP: thymic stromal lymphopoietin
NM: Conceptualization, Data curation, Investigation, Writing—original draft, Writing—review and editing. MB: Data curation, Validation, Writing—review and editing. HIM: Conceptualization, Data curation, Investigation, Writing—review and editing. All authors read and approved the submitted version.
The author declares that there are no conflicts of interest.
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