Novel treatment in Asthma and COPD with Biologic agents.
Asthma management has evolved significantly with the introduction of biologic therapies, especially for patients with severe, uncontrolled asthma . Like type 2 asthma with stimulations to T helper 2 and some cytokines releasing which cause an uncontrolled , severe asthma or exacerbation of COPD. These agents target specific components of the immune system involved in airway inflammation, offering tailored treatment options. Below is an overview of notable biologic agents, including recent advancements
Omalizumab (Xolair) : Omalizumab target at IgE , preventing the IgE – receptor action. Approved for using in various IgE mediated food allergy , chronic spontaneous urticaria (CSU) and severe asthma , Chronic rhinosinusitis with nasal Polyp (CRSwNP)
Tezepelumab (Tezspire): Tezepelumab is a human monoclonal antibody that inhibits thymic stromal lymphopoietin (TSLP), a cytokine implicated in initiating airway inflammation. Approved for use in individuals aged 12 and older with severe asthma, it has demonstrated efficacy in reducing asthma exacerbations across various patient populations. Dosage 210 mg sc every 4 weeks.
Mepolizumab (Nucala) : Injection .The agent interact with interleukin-5 receptor (IL-5R) to prevent IL-5 targeted receptor . Using in severe asthma in child and adult , CRSwNP , Eosinophilic granulomatosis with polyangiitis (EGPA) , Hypereosinophilic syndrome (HES) dosage 100-300 mg sc every 4 weeks.
Benralizumab (Fasenra): Benralizumab targets the interleukin-5 receptor (IL-5R) on eosinophils, leading to their depletion. It is approved for the treatment of severe eosinophilic asthma. Recent studies suggest that benralizumab may be more effective than traditional oral steroids during acute asthma attacks, reducing the need for further treatment by 30%. , also useful for EGPA
Astegolimab: Astegolimab is an investigational monoclonal antibody targeting the ST2 receptor, which is involved in the inflammatory response associated with asthma. It is being evaluated for its potential to treat asthma and chronic obstructive pulmonary disease (COPD), particularly in patients with low eosinophil counts.
Dupilumab (Dupixent): Dupilumab is a monoclonal antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling, key drivers of type 2 inflammation. While primarily approved for conditions like eczema, atopic dermatitis , severe asthma , CRSwNP , Prurigo nodularis , EoE and recent developments have expanded its use to treat COPD to prevent exacerbation(300 mg alternate week), marking it as the first biologic treatment for this condition.
These biologic agents represent significant advancements in asthma treatment, offering personalized approaches based on the underlying inflammatory pathways of the disease. Ongoing research continues to refine their efficacy and safety profiles, aiming to enhance outcomes for patients with severe asthma.