title: Pharmacological Therapy of Bronchial Asthma: The Role of Biologicals.
abstract: Bronchial asthma is a heterogeneous, complex, chronic inflammatory and obstructive pulmonary disease driven by various pathways to present with different phenotypes. A small proportion of asthmatics (5-10%) suffer from severe asthma with symptoms that cannot be controlled by guideline therapy with high doses of inhaled steroids plus a second controller, such as long-acting β2 agonists (LABA) or leukotriene receptor antagonists, or even systemic steroids. The discovery and characterization of the pathways that drive different asthma phenotypes have opened up new therapeutic avenues for asthma treatment. The approval of the humanized anti-IgE antibody omalizumab for the treatment of severe allergic asthma has paved the way for other cytokine-targeting therapies, particularly those targeting interleukin (IL)-4, IL-5, IL-9, IL-13, IL-17, and IL-23 and the epithelium-derived cytokines IL-25, IL-33, and thymic stromal lymphopoietin. Knowledge of the molecular basis of asthma phenotypes has helped, and continues to help, the development of novel biologicals that target a diverse array of phenotype-specific molecular targets in patients suffering from severe asthma. This review summarizes potential therapeutic approaches that are likely to show clinical efficacy in the near future, focusing on biologicals as promising novel therapies for severe asthma.
authors.affiliation: Department of Experimental Pneumology and Allergology, Saarland University Faculty of Medicine, Homburg/Saar, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Heck
authors.forename: Juliane
authors.initials: J
authors.lastname: Nguyen
authors.forename: Duc-Dung
authors.initials: DD
authors.lastname: Le
authors.forename: Robert
authors.initials: R
authors.lastname: Bals
authors.forename: Quoc Thai
authors.initials: QT
authors.lastname: Dinh
mesh_terms: D018927:Anti-Asthmatic Agents / Q000302:isolation & purification / Q000378:metabolism / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D001688:Biological Products / Q000302:isolation & purification / Q000378:metabolism / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D016207:Cytokines / Q000037:antagonists & inhibitors; D003713:Dendritic Cells / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007378:Interleukins / Q000037:antagonists & inhibitors*; D008214:Lymphocytes / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D000069444:Omalizumab / Q000302:isolation & purification / Q000378:metabolism / Q000627:therapeutic use*; D010641:Phenotype; D012720:Severity of Illness Index; D000094632:Thymic Stromal Lymphopoietin
chemical_list: D018927:Anti-Asthmatic Agents; D001688:Biological Products; D016207:Cytokines; D007378:Interleukins; D000069444:Omalizumab; D007073:Immunoglobulin E; D000094632:Thymic Stromal Lymphopoietin