title: Monoclonal Anti-TNF-α Antibodies for Severe Steroid-Dependent Asthma: A Case Series.
abstract: BACKGROUND
  Refractory asthma represents an important condition, with considerable morbidity and mortality. Tumor necrosis factor α (TNF-α) is a potential target for treatment of severe asthma. However, controlled studies have shown controversial results and the risk-benefit profile of TNF-blocking agents is still debated.
  
  
  OBJECTIVE
  To describe the effect of infliximab on asthma control in patients with severe, uncontrolled, steroid-dependent asthma.
  
  
  METHODS
  From 2007 to 2010, 7 patients received infliximab in our center. All had severe refractory asthma, with frequent severe exacerbations and hospitalizations in the intensive care unit despite maximal inhaled treatment, daily oral steroids and omalizumab treatment.
  
  
  RESULTS
  Asthma control improved in the 6 patients who received infliximab for at least 3 months. Oral steroids could be stopped in 4 and the frequency of exacerbations and hospitalizations was greatly reduced, especially for the 3 patients with brittle asthma. Two patients showed severe adverse effects (bacterial pneumonia and extension of spreading melanoma). Three patients have received infliximab for more than 2 years, with good tolerance.
  
  
  CONCLUSIONS
  This case series suggests that anti-TNF-α drugs may improve the condition of a subgroup of patients with severe steroid-refractory asthma, with a favourable risk-benefit profile for most, considering asthma severity, occurrence of life-threatening exacerbations and complications of long-term oral steroids. Specific controlled trials of this subgroup are warranted.
authors.affiliation: Service de Pneumologie, Hôpital Bichat, Assistance Publique - Hôpitaux de Paris, Paris, France ; Université Paris Diderot - Paris 7, Paris, France ; INSERM Unité 700, Faculté de Médecine Bichat, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Taillé
authors.forename: Claire
authors.initials: C
authors.lastname: Poulet
authors.forename: Sylvain
authors.initials: S
authors.lastname: Marchand-Adam
authors.forename: Raphaël
authors.initials: R
authors.lastname: Borie
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Dombret
authors.forename: Bruno
authors.initials: B
authors.lastname: Crestani
authors.forename: Michel
authors.initials: M
authors.lastname: Aubier
keywords: TNF-α; anti-TNF-α drug; brittle asthma.; severe refractory asthma