Treatment of severe asthma: entering the era of targeted therapy.
BACKGROUND
It is estimated that 5 - 10% of asthma patients suffer from severe asthma. Severe asthma is associated with increased morbidity and mortality. These patients are not controlled with currently available treatments and therefore additional treatment options are needed. Asthma is a heterogeneous disease, and different asthma patient groups probably have different underlying pathophysiology. Novel therapies with, for example, monoclonal antibodies that target certain immunological pathways have become available. These novel treatments are not effective in all patients but only in certain phenotypes.


METHODS
This review covers the current evidence and novel developments in treatment with monoclonal antibodies in different asthma phenotypes. This includes monoclonal antibodies against IgE, against interleukin (IL)-5 and antibodies targeting IL-13 pathways. Although there is a certain overlap between patient groups benefiting from these treatments, a more detailed identification of responder profiles for these therapies is needed for personalized therapy.


CONCLUSIONS
In recent years, novel monoclonal antibodies have been developed, which are a promising addition to existing therapy in the treatment of severe asthma with eosinophilic inflammation and Th2-driven disease. We expect that several of the new antibodies will become available for clinical practice. In addition, it must be acknowledged that so far no effective strategies are available for patients with non-eosinophilic asthma and further research and development is necessary for this patient group.
a Leiden University Medical Center, Department of Pulmonology , Leiden, The Netherlands +31 7 15 26 29 50 ; +31 7 15 26 69 27 ; c.taube@lumc.nl.
Amanda R
AR
van Buul
a Leiden University Medical Center, Department of Pulmonology , Leiden, The Netherlands +31 7 15 26 29 50 ; +31 7 15 26 69 27 ; c.taube@lumc.nl.
Christian
C
Taube
D000818:Animals; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000276:immunology; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016503:Drug Delivery Systems / Q000379:methods / Q000639:trends*; D006801:Humans; D018793:Interleukin-13 / Q000037:antagonists & inhibitors / Q000276:immunology; D015848:Interleukin-5 / Q000037:antagonists & inhibitors / Q000276:immunology; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; C508599:IL5 protein, human; D018793:Interleukin-13; D015848:Interleukin-5
asthma therapy; monoclonal antibodies; pharmacological treatment; severe asthma; targeted therapy