Eosinophilic Asthma Resource Centre

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Targeted Therapies for the Treatment of Eosinophilic Asthma: Focus on IL-5

Speaker: Mario Castro MD, MPH

Targeted Therapies for the Treatment of Eosinophilic Asthma: Focus on IL-5

In this webcast Prof. Castro discusses recent advances in the treatment of severe asthma, including the treatment shift from inhaled glucocorticoids to targeted therapy and new drug that target specific inflammatory mediators with a focus on anti-IL-5 therapies.

summary

Dr Castro discusses the shift from current asthma therapies to biologic therapies, looks at promising new drugs that target specific inflammatory mediators in different types of severe asthma, and describes clinical data on IL-5 therapies for severe asthma.

The rationale for targeted therapy is to provide effective and safe treatments with minimal side effects in the 10-15% of patients who are not controlled using conventional treatments.  

Currently moderate-to-severe allergic asthma can be controlled using the anti-IgE monoclonal antibody Omalizumab.

Biologics currently under early investigation for the treatment of severe asthma include anti-IL-13 monoclonal antibodies tralokinumab and lebrikizumab. IL-13 is responsible for T2 inflammation and mucin production in the airways of severe asthma patients.

Dupilumab is an anti-IL-4/13 antibody that is showing promise based on a Phase IIB clinical trial.

Eosinophilic asthma is emerging as a distinct phenotype, and differentiation, proliferation and activation of eosinophils is mediated by IL-5. Mepolizumab is an anti-IL-5 monoclonal antibody against IL-5 and is approved as an add-on treatment for severe refractory eosinophilic asthma in adults. Of note, it can help to reduce the dosage (of up to 50%) of patients who require chronic oral steroids.

Reslizumab is another approved anti-IL-5 monoclonal antibody and is approved in the USA as an add-on maintenance treatment for adults with severe eosinophilic asthma. Reslizumab particularly benefits patients with nasal polyposis.  It was also shown to reduce exacerbations by over 50% and improve control.

Benralizumab, which inhibits the IL-5 receptor, is not approved, but is showing some promise in patients with blood eosinophils ≥300 cells/µL for reducing exacerbations relative to placebo.

Prof Castro concludes that specific severe asthma phenotypes can be identified and treated using biologic therapies.