Page 65 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 65
y and safety data from extended studies of benralizumab every 8 weeks may also be im- 65
key trials as well as experience from everyday portant for some patients.
clinical practice, the uncertainties associated mon i tor i ng a n d eva luat ion of t h e r a peu t ic r e sponse i n pat i e n ts w i t h sev e r e a st h m a on biologic s
with these treatments are very small10. A weight-based dosing regimen of resli-
zumab may provide a good response in cases
The EAACI 2021 use the GRADE ap- that have failed to respond to other anti-IL5
proach in making recommendations for each biologics. Only reslizumab has to be given
biologic both in terms of its use and therapeu- intravenously, which may be important for
tic effect assessment11. some patients. Very rare cases of anaphylax-
is have been reported in clinical studies with-
According to the 2021 EAACI Guide- in the first 20 minutes after reslizumab infu-
lines, a reduction in exacerbations, an im- sion20.
provement in quality of life, a reduction in the
use of ICS as well as the use of rescue drugs, Long-term efficacy of dupilumab has
and global efficacy can be expected with high been demonstrated in both allergic and eosin-
certainty in patients treated with omalizum- ophilic phenotypes. The good safety profile of
ab. Improvement in asthma control is expect- dupilumab is known from previous studies for
ed with moderate certainty11. Real-life studies atopic dermatitis. Dupilumab is well tolerat-
have shown the efficacy of omalizumab re- ed, but ocular side effects are common21.
gardless of blood eosinophil status12,13. Long-
term treatment with omalizumab did not In endemic areas, patients treated with
increase the risk of side effects, especially ana- anti IL-5 b iologics, should be screened for
phylaxis14. parasitic infections11.
The EAACI recommendations for treat- Tezepelumab is the first drug in a class
ment with mepolizumab to reduce asthma ex- of new b iologics that targets and blocks thy-
acerbations and to resolve or reduce OCS are mic stromal lymphopoietin (TSLP), which
strong. The effect of mepolizumab on asthma sits at the top of the inflammatory cascades.
control, quality of life and lung function in The mechanism and site of action of tezepe-
studies was good, but less clear15,16. The great- lumab stops the release of inflammatory cy-
est positive change in symptoms and lung tokines at the very source and therefore this
function observed during the first months drug has the potential to treat a wide popu-
of treatment with mepolizumab17. No seri- lation of patients with severe asthma regard-
ous side effects associated with mepolizumab less of phenotype. Randomized trials of teze-
were reported in real-life studies18. pelumab showed fewer exacerbations, better
lung function, better asthma control, and bet-
According to the EAACI 2021 recom- ter health-related quality of life in patients
mendations, there is high certainty that ben- with severe asthma who received it22. Consid-
ralizumab reduces asthma exacerbations ering that it has only recently been available
and OCS in a subgroup of adult asthmatics in daily clinical practice, the experiences of
with severe asthma with > 150 eosinophils/ clinicians are still expected.
μL. There is also great certainty for patients
treated with benralizumab that asthma con- Comparison between b iologics
trol and quality of life will improve11. Fol-
low-up of 1,600 asthma patients treated with The assessment of the therapeutic effect of bi-
benralizumab for 2 years did not indicate an ologic drugs in severe asthma depends on a
increased risk of infections or malignancies, number of factors that differed significant-
but further long-term follow-up is needed to ly between studies and that can modulate
assess possible risks of eosinophil depletion the therapeutic response. In differed studies,
during benralizumab treatment19. Dosage of there are different inclusion or exclusion cri-
teria related to asthma severity, lung function,
key trials as well as experience from everyday portant for some patients.
clinical practice, the uncertainties associated mon i tor i ng a n d eva luat ion of t h e r a peu t ic r e sponse i n pat i e n ts w i t h sev e r e a st h m a on biologic s
with these treatments are very small10. A weight-based dosing regimen of resli-
zumab may provide a good response in cases
The EAACI 2021 use the GRADE ap- that have failed to respond to other anti-IL5
proach in making recommendations for each biologics. Only reslizumab has to be given
biologic both in terms of its use and therapeu- intravenously, which may be important for
tic effect assessment11. some patients. Very rare cases of anaphylax-
is have been reported in clinical studies with-
According to the 2021 EAACI Guide- in the first 20 minutes after reslizumab infu-
lines, a reduction in exacerbations, an im- sion20.
provement in quality of life, a reduction in the
use of ICS as well as the use of rescue drugs, Long-term efficacy of dupilumab has
and global efficacy can be expected with high been demonstrated in both allergic and eosin-
certainty in patients treated with omalizum- ophilic phenotypes. The good safety profile of
ab. Improvement in asthma control is expect- dupilumab is known from previous studies for
ed with moderate certainty11. Real-life studies atopic dermatitis. Dupilumab is well tolerat-
have shown the efficacy of omalizumab re- ed, but ocular side effects are common21.
gardless of blood eosinophil status12,13. Long-
term treatment with omalizumab did not In endemic areas, patients treated with
increase the risk of side effects, especially ana- anti IL-5 b iologics, should be screened for
phylaxis14. parasitic infections11.
The EAACI recommendations for treat- Tezepelumab is the first drug in a class
ment with mepolizumab to reduce asthma ex- of new b iologics that targets and blocks thy-
acerbations and to resolve or reduce OCS are mic stromal lymphopoietin (TSLP), which
strong. The effect of mepolizumab on asthma sits at the top of the inflammatory cascades.
control, quality of life and lung function in The mechanism and site of action of tezepe-
studies was good, but less clear15,16. The great- lumab stops the release of inflammatory cy-
est positive change in symptoms and lung tokines at the very source and therefore this
function observed during the first months drug has the potential to treat a wide popu-
of treatment with mepolizumab17. No seri- lation of patients with severe asthma regard-
ous side effects associated with mepolizumab less of phenotype. Randomized trials of teze-
were reported in real-life studies18. pelumab showed fewer exacerbations, better
lung function, better asthma control, and bet-
According to the EAACI 2021 recom- ter health-related quality of life in patients
mendations, there is high certainty that ben- with severe asthma who received it22. Consid-
ralizumab reduces asthma exacerbations ering that it has only recently been available
and OCS in a subgroup of adult asthmatics in daily clinical practice, the experiences of
with severe asthma with > 150 eosinophils/ clinicians are still expected.
μL. There is also great certainty for patients
treated with benralizumab that asthma con- Comparison between b iologics
trol and quality of life will improve11. Fol-
low-up of 1,600 asthma patients treated with The assessment of the therapeutic effect of bi-
benralizumab for 2 years did not indicate an ologic drugs in severe asthma depends on a
increased risk of infections or malignancies, number of factors that differed significant-
but further long-term follow-up is needed to ly between studies and that can modulate
assess possible risks of eosinophil depletion the therapeutic response. In differed studies,
during benralizumab treatment19. Dosage of there are different inclusion or exclusion cri-
teria related to asthma severity, lung function,
