Targeted anti-IL-13 therapies in asthma: current data and future perspectives

ABSTRACT

Introduction: The identification of patients with severe asthma who will benefit from a personalized management approach remains an unmet need. Interleukin-13 (IL-13) is a cytokine possessing a significant role in asthma pathogenesis and progression of disease. Humanised monoclonal antibodies against IL-13 and IL-13 and IL-4 receptors are mainly proposed as add-on therapy in patients with T_H2-high inflammation with uncontrolled asthma despite maximum therapy.

Areas covered: The role of IL-13 in airway inflammation in severe asthma, the targeted anti-IL-13 therapies and biomarkers that predict response to anti-IL-13 treatment are discussed.

Expert opinion: New effective individualized therapies in severe asthma are urgently needed to block specific inflammatory pathways using monoclonal antibodies. Studies on anti-IL-13 therapies showed that asthmatic patients could benefit from this novel targeted therapy as far as lung function and exacerbation rate are concerned. T_H2-high and especially periostin-high groups of asthmatics with moderate-to-severe uncontrolled asthma seem to compose the group that could benefit from anti-IL-13 therapy. Targeting IL-13 alone may not be sufficient to achieve asthma control. Inhibition of IL-13 and IL-4 with mabs may be more encouraging and patients will probably have additional benefits from these therapeutic interventions because of IL-13/IL-4 overlapping actions in asthma pathophysiology.

KEYWORDS:

• Asthma
• biomarkers
• Interleukin-13
• targeted therapies

Article highlights

• Inhibition of IL-13 alone, despite the initial encouraging results, failed to show a positive input in the management of severe asthma. The stratification in future studies needs a different approach combining biomarkers such as Periostin, blood eosinophils and FeNO.

• Targeting IL-13 alone may not be sufficient to achieve asthma control. Dupilumab, which inhibits IL-13 and IL-14, increased lung function and reduced severe exacerbations in patients with uncontrolled asthma irrespective of baseline eosinophil count.

• Emphasis should be given in the long-term safety of biological agents and in the appropiate use because of the excessive cost.

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Declaration of interest

The authors have 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.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was not funded.