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Asthma and exacerbation; the importance of patient stratification for using reslizumab, mepolizumab or omalizumab
Professor Jean Bousquet discusses the challenges in defining treatment for patients with exacerbations despite optimal treatment.
Approximately 10% of people in the Western world have asthma. Of these, about 3-5% are poorly controlled despite optimal treatment. Anti-IL-5 antibodies (targeting eosinophils) were developed in the 1990s but only approved in 2015-2016. Initially, both reslizumab and mepolizumab failed due to improper selection of the subject populations in the original clinical trials. It was subsequently determined in later clinical trials that both drugs are effective in a subset of asthmatics – specifically exacerbations. Based on these results, Prof Bousquet reinforces the need to stratify patients.
Omalizumab targets IgE and was the first biologic to be approved that targets exacerbations and was an important study for helping to understand how to assess asthma for regulators.
The doctor is faced with a choice to give an anti-IL-5 or an anti-IgE. Prof Bousquet suggests the following simplification on stratifying severe asthmatics: 1) If allergy is present with higher IgE level and exacerbations give omalizumab. If the patient is non-allergic with high eosinophils, then try an anti-IL-5 drug.