Page 120 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 120
In phase 3, RCT tezepelumab as add- therapy in those patients with elevated eosin-
one therapy in uncontrolled severe asthma ophils while IgE is in the reference values. If
severe asthma forum 1: severe asthma - basic and clinical views at a dose of 230 mg administered subcutane- there is no effect of IL-5 therapy, bronchial
ously every 4 weeks in adolescents and adults, thermoplasty should be considered as in those
has reduced the annual exacerbation rate by patients with low IgE and low eosinophils.22
56%, and among patients with blood eosin- Patients who have an intermediate response to
ophil counts less than 300 cells/µL reduced therapy either need to continue treatment for
exacerbation rate by 41%. In addition, teze- one year to assess response or consider switch-
pelumab has improved lung function, asth- ing to alternative biologic therapy if a thera-
ma control and the quality of life in the T2- peutic effect is absent. Clinical experience and
high asthma group, but also in the T2-low new research may identify a panel of new bi-
asthma group. A rapid decline in blood eosin- omarkers that will better predict a positive re-
ophil counts, a decrease in FeNO, a gradual sponse to biological therapy and facilitate our
reduction in serum total IgE and a reduction therapeutic option.43
in bronchial hyperreactivity were observed.
Safety profile of tezepelumab was similar to Unfortunately, none of the biological
placebo.45,46 agents can meet the needs of patients whose
asthma is not mediated by a T2 response (T2-
Itepekimab (anti IL-33) in phase 2 RCT low asthma). Due to our limited understand-
at a dose of 300 mg sc every 2 weeks has re- ing of the immune response of in T2 low asth-
duced exacerbations and improved lung func- ma, our therapeutic options are very limited
tion in patients with moderate to severe un- and are a reflection of unmet needs in severe
controlled asthma45,47, while astegolimab (anti uncontrolled asthma.22,44
IL-33R) in phase 2 RCT was administered
subcutaneously every 4 weeks in patients with References
severe asthma, including those with low pe-
ripheral blood eosinophils, reduced the rate of 1. Data, statistics, and surveillance [Inter-
exacerbations, but did not improve lung func- net]. Atlanta, GA: Centers for Disease
tion.45,48 Positive results of phase 3 RCTs of Control and Prevention; [updated 2021
monoclonal antibodies efficacy against epi- Sep 16]. Available from: https://www.
thelial cytokines are expected, especially for cdc.gov/asthma/asthmadata.htm.
T2-low asthma.
2. Respiratory disease statistics [Internet].
Numerous elements contribute to the re- Eurostat. Available from: http://ec.eu-
sponse to biologic treatment and individual ropa.eu/eurostat/statisticsexplained/in-
patient responses will vary. The monitoring dex.php/Respiratory _diseases_statis-
of lung function, the presence of symptoms, tics/.
number of exacerbations and quality of life
may help in early clinical assessment of re- 3. Global Initiative for Asthma [Internet].
sponse to treatment. Identifying patients with GINA; c2022. Available from: http://
a therapeutic response and those who do not ginasthma.org/.
respond to biologic therapy is not easy. Sug-
gested approach to the treatment of severe 4. Hekking PP, Reinier RW, Amelink M,
asthma beyond standard therapies involves et al. The prevalence of severe refrac-
the treatment omalizumab in case of elevat- tory asthma. J Allergy Clin Immunol.
ed IgE and positive perennial antigen. Af- 2015 Apr;135(4):896-902.
ter 4-6 months, an assessment follows and if
treatment has no effect, switch to anti-IL-5 5. Chen S ,Golam S, Myers J, et al. Sys-
tematic literature review of the clini-
cal, humanistic, and economic burden
associated with asthma uncontrolled
by GINA Steps 4 or 5 treatment. Curr
one therapy in uncontrolled severe asthma ophils while IgE is in the reference values. If
severe asthma forum 1: severe asthma - basic and clinical views at a dose of 230 mg administered subcutane- there is no effect of IL-5 therapy, bronchial
ously every 4 weeks in adolescents and adults, thermoplasty should be considered as in those
has reduced the annual exacerbation rate by patients with low IgE and low eosinophils.22
56%, and among patients with blood eosin- Patients who have an intermediate response to
ophil counts less than 300 cells/µL reduced therapy either need to continue treatment for
exacerbation rate by 41%. In addition, teze- one year to assess response or consider switch-
pelumab has improved lung function, asth- ing to alternative biologic therapy if a thera-
ma control and the quality of life in the T2- peutic effect is absent. Clinical experience and
high asthma group, but also in the T2-low new research may identify a panel of new bi-
asthma group. A rapid decline in blood eosin- omarkers that will better predict a positive re-
ophil counts, a decrease in FeNO, a gradual sponse to biological therapy and facilitate our
reduction in serum total IgE and a reduction therapeutic option.43
in bronchial hyperreactivity were observed.
Safety profile of tezepelumab was similar to Unfortunately, none of the biological
placebo.45,46 agents can meet the needs of patients whose
asthma is not mediated by a T2 response (T2-
Itepekimab (anti IL-33) in phase 2 RCT low asthma). Due to our limited understand-
at a dose of 300 mg sc every 2 weeks has re- ing of the immune response of in T2 low asth-
duced exacerbations and improved lung func- ma, our therapeutic options are very limited
tion in patients with moderate to severe un- and are a reflection of unmet needs in severe
controlled asthma45,47, while astegolimab (anti uncontrolled asthma.22,44
IL-33R) in phase 2 RCT was administered
subcutaneously every 4 weeks in patients with References
severe asthma, including those with low pe-
ripheral blood eosinophils, reduced the rate of 1. Data, statistics, and surveillance [Inter-
exacerbations, but did not improve lung func- net]. Atlanta, GA: Centers for Disease
tion.45,48 Positive results of phase 3 RCTs of Control and Prevention; [updated 2021
monoclonal antibodies efficacy against epi- Sep 16]. Available from: https://www.
thelial cytokines are expected, especially for cdc.gov/asthma/asthmadata.htm.
T2-low asthma.
2. Respiratory disease statistics [Internet].
Numerous elements contribute to the re- Eurostat. Available from: http://ec.eu-
sponse to biologic treatment and individual ropa.eu/eurostat/statisticsexplained/in-
patient responses will vary. The monitoring dex.php/Respiratory _diseases_statis-
of lung function, the presence of symptoms, tics/.
number of exacerbations and quality of life
may help in early clinical assessment of re- 3. Global Initiative for Asthma [Internet].
sponse to treatment. Identifying patients with GINA; c2022. Available from: http://
a therapeutic response and those who do not ginasthma.org/.
respond to biologic therapy is not easy. Sug-
gested approach to the treatment of severe 4. Hekking PP, Reinier RW, Amelink M,
asthma beyond standard therapies involves et al. The prevalence of severe refrac-
the treatment omalizumab in case of elevat- tory asthma. J Allergy Clin Immunol.
ed IgE and positive perennial antigen. Af- 2015 Apr;135(4):896-902.
ter 4-6 months, an assessment follows and if
treatment has no effect, switch to anti-IL-5 5. Chen S ,Golam S, Myers J, et al. Sys-
tematic literature review of the clini-
cal, humanistic, and economic burden
associated with asthma uncontrolled
by GINA Steps 4 or 5 treatment. Curr
