The emergence of new biologics for severe asthma

• Published in: Current opinion in pharmacology 2019-06, Vol.46, p.108-115
• Main Authors: Eger, Katrien AB, Bel, Elisabeth H
• Format: Article
• Language: English
• ISSN: 1471-4892; 1471-4973
• DOI: 10.1016/j.coph.2019.05.005

•Dupilumab: an anti-IL-4/IL-13 biologic has been FDA approved for severe asthma.•Tralokinumab, lebrikizumab: two anti-IL-13 biologics for asthma, failed in phase 3.•Tezepelumab: an upstream biologic, reduces exacerbations in Th2 high and low asthma.•Benralizumab: another anti-IL-5 with oral glucocorticoid-sparing effects in asthma.•Future asthma treatments will focus on targeting multiple inflammatory pathways. Patients with severe asthma experience severe symptoms and frequent exacerbations despite intensive treatment with inhaled and oral glucocorticoids. Biologics for severe asthma aim to reduce asthma-related and glucocorticoid-induced morbidity. Recently, new biologics targeting interleukin (IL)-5, IL-5 receptor and IL-4/IL-13, which are all cytokines involved in so-called type 2 airway inflammation, were approved for severe asthma. They show a reduction in exacerbation rate and an oral glucocorticoid-sparing effect. Studies with upstream biologics targeting alarmin cytokines such as thymic stromal lymphopoietin (TSLP) and IL-33 are underway, and newly designed bispecific antibodies targeting more than one pathway are in early phases of development. Such pathway-targeted add-on treatments will soon become standard of care for all patients with severe asthma.