Decoding treatment efficacy: uncovering response and failure dynamics to biologics in asthma

ABSTRACT

Introduction

Asthma is a global health problem, with alarming prevalence and mortality rates. Biologic therapies, particularly monoclonal antibodies such as omalizumab, have emerged as promising alternatives, targeting specific immune pathways. This article assesses the efficacy of these biologics in asthma management and attempts to reveal factors associated with their response and failure dynamics.

Area covered

This article explores the efficacy of biologics in asthma, biomarkers, and the relationship between asthma phenotypes (including eosinophilic and non-eosinophilic (neutrophilic) types) and biologic treatments; particularly their effectiveness for each subtype.

Expert opinion

Personalized asthma management that incorporates molecular insights as well as individual variations is of outmost necessity. An emphasis is put on immunological profiling, understanding comorbidities and considering individual patient factors when managing asthma. Cutting-edge phenotyping tools including omic technologies play a crucial role in improving asthma management precision. Variability in patient responses to biologic treatments such as non-responders, partial responders and super responders poses a formidable challenge to effective asthma care management strategies.

KEYWORDS:

• Asthma
• biological therapy
• precision medicine
• targeted therapy
• immunity

Article highlights

• Monoclonal antibodies such as omalizumab, mepolizumab, and dupilumab effectively manage severe asthma, particularly in cases of Type 2 inflammation

• Biomarkers like blood eosinophils, serum total IgE levels, and exhaled nitric oxide (FeNO) are critical in identifying patients who would benefit most from biologic therapies.

• There is a need for more precise biomarkers to differentiate responder subgroups effectively.

• Eosinophilic asthma, characterized by high eosinophil levels, responds well to biologic treatments, significantly reducing severe asthma flare-ups.

• Non-eosinophilic (neutrophilic) asthma shows a less favorable response, indicating a treatment gap for this subtype.

• It is essential to personalize the management of asthma by taking into account factors to each patient such as their immune profile, existing health conditions and how they have responded to previous treatments.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have received honoraria from AstraZeneca, Chiesi, Genentech, GSK and Sanofi for giving disease state lectures on asthma, unrelated to this review. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

The paper was not funded.