title: Future biologic therapies in asthma.
abstract: Despite the administration of appropriate treatment, a high number of patients with asthma remain uncontrolled. This suggests the need for alternative treatments that are effective, safe and selective for the established asthma phenotypes, especially in patients with uncontrolled severe asthma. The most promising options among the new asthma treatments in development are biological therapies, particularly those monoclonal antibodies directed at selective targets. It should be noted that the different drugs, and especially the new biologics, act on very specific pathogenic pathways. Therefore, determination of the individual profile of predominant pathophysiological alterations of each patient will be increasingly important for prescribing the most appropriate treatment in each case. The treatment of severe allergic asthma with anti-IgE monoclonal antibody (omalizumab) has been shown to be effective in a large number of patients, and new anti-IgE antibodies with improved pharmacodynamic properties are being investigated. Among developing therapies, biologics designed to block certain pro-inflammatory cytokines, such as IL-5 (mepolizumab) and IL-13 (lebrikizumab), have a greater chance of being used in the clinic. Perhaps blocking more than one cytokine pathway (such as IL-4 and IL-13 with dulipumab) might confer increased efficacy of treatment, along with acceptable safety. Stratification of asthma based on the predominant pathogenic mechanisms of each patient (phenoendotypes) is slowly, but probably irreversibly, emerging as a tailored medical approach to asthma, and is becoming a key factor in the development of drugs for this complex respiratory syndrome.
authors.affiliation: Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España. Electronic address: santiago.quirce@salud.madrid.org.
authors.forename: Santiago
authors.initials: S
authors.lastname: Quirce
authors.affiliation: Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España.
authors.forename: Irina
authors.initials: I
authors.lastname: Bobolea
authors.affiliation: Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Domínguez-Ortega
authors.affiliation: Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Barranco
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy / Q000628:therapy*; D001685:Biological Factors / Q000627:therapeutic use; D001691:Biological Therapy / Q000639:trends*; D002986:Clinical Trials as Topic; D016207:Cytokines / Q000037:antagonists & inhibitors; D015195:Drug Design; D005544:Forecasting; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007378:Interleukins / Q000037:antagonists & inhibitors; D058990:Molecular Targeted Therapy; D013601:T-Lymphocytes / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018927:Anti-Asthmatic Agents; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D001685:Biological Factors; D016207:Cytokines; D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha; C026408:anti-IgE antibodies; D007073:Immunoglobulin E
keywords: Agentes biológicos; Anticuerpos monoclonales; Asma; Asthma; Biological agents; Monoclonal antibodies; Therapy; Tratamiento