Biological treatments for severe asthma.
Purpose of review: Asthma is a heterogenous disease associated with different phenotypes and endotypes. The unmet needs with severe asthma have led to the emergence of potential therapeutic targets beyond the existing therapies. Recently, several biologics were examined and some have now been approved to target T2 airway inflammation in patients with severe disease. We provide an overview of recently approved biologic, those which are emerging and highlight unmet needs in this area.
Recent findings: Multiple biologics targeting T2 high asthma are now available for clinical use in the appropriate groups of severe asthma. These target overlapping phenotypes, which include allergic and eosinophilic asthma. Available biologics were shown to improve outcomes that include the reduction of exacerbations and improvement of lung function. Some have also demonstrated improvement in patient-reported outcomes. Some of these biologics have also demonstrated beneficial effects on associated asthma comorbidities. Biomarkers help predict response to certain biologics, although only few currently exist. Emerging biologics blocking other pathways of airway inflammation are under development. Several small molecule antagonists and inhibitors are also in development. Biologics and therapies targeting T2 low or non-T2 asthma are needed.
Summary: Recently approved biologic therapies improve asthma outcomes in subset of patients. Future research to uncover better predictors of response can improve the precise approach to therapy of patients with severe disease.