Patient-Oriented Application of New Monoclonal Antibodies for Severe Asthma

Asthma is a chronic lung disease that occurs due to many genetic and environmental factors. In the Global Initiative for Asthma (GINA) guideline, anti-immunoglobulin E (anti-IgE) (omalizumab) for patients with allergic asthma, anti-interleukin-5 (mepolizumab and reslizumab) or anti-interleukin 5 receptor (benralizumab) for patients with severe eosinophilic asthma are recommended as add-on treatment if the patients remain uncontrolled on STEP-4 treatment. Omalizumab, a humanized monoclonal antibody, inhibits the immunologic effects of immunoglobulin E (IgE) that binds to circulating high affinity IgE receptor. Mepolizumab acts by binding to interleukin-5 (IL-5), a cytokine required for the development of eosinophils, and reduces eosinophil levels. Although the mechanisms of action are similar, the magnitude of the patient’s airway inflammation, the severity of the disease, and the phenotypic differences of the patients may be important for the treatment decisions. Even though in GINA, omalizumab is recommended as add-on treatment in STEP-5 for ≥6 years of age moderate to severe allergic asthma, in our country it was approved for the same phenotypic patients who were over 12 years of age. Both clinical trials and real world experience data support efficacy and safety of omalizumab for the treatment of moderate-to-severe allergic asthma. Evidence for clinical use in non allergic asthma as well as other investigational uses are already limited.