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Volume 2, 2015

Volume 1, 2014

Severe asthma: anti-IgE or anti-IL-5?

Content Provider	Taylor & Francis Online
Author	Loukides, Stelios Bakakos, Petros Papathanassiou, Evgenia
Abstract	Severe asthma is a discrete clinical entity characterised by recurrent exacerbations, reduced quality of life and poor asthma control as ordinary treatment regimens remain inadequate. Difficulty in managing severe asthma derives partly from the multiple existing phenotypes and our inability to recognise them. Though the exact pathogenetic pathway of severe allergic asthma remains unclear, it is known that numerous inflammatory cells and cytokines are involved, and eosinophils represent a key inflammatory cell mediator. Anti-IgE (omalizumab) and anti-IL-5 (mepolizumab) antibodies are biological agents that interfere in different steps of the Th2 inflammatory cascade and are licensed in severe asthma. Both exhibit a favourable clinical outcome as they reduce exacerbation rate and improve asthma control and quality of life, while mepolizumab also induces an oral steroid sparing effect. Nevertheless, it is still questionable which agent is more suitable in the management of severe allergic asthma since no comparable studies have been conducted. Omalizumab's established effectiveness in clinical practice over a long period is complemented by a beneficial effect on airway remodelling process mediated mainly through its impact on eosinophils and other parameters strongly related to eosinophilic inflammation. However, it is possible that mepolizumab through nearly depleting eosinophils could have a similar effect on airway remodelling. Moreover, to date, markers indicative of the patient population responding to each treatment are unavailable although baseline eosinophils and exacerbation rate in the previous year demonstrate a predictive value regarding anti-IL-5 therapy effectiveness. On the other hand, a better therapeutic response for omalizumab has been observed when low forced expiratory volume in 1 sec, high-dose inhaled corticosteroids and increased IgE concentrations are present. Consequently, conclusions are not yet safe to be drawn based on existing knowledge, and additional research is necessary to unravel the remaining issues for the severe asthmatic population.
File Format	PDF HTM / HTML
ISSN	20018525
DOI	10.3402/ecrj.v3.31813
Journal	European Clinical Respiratory Journal
Volume Number	3
Issue Number	1
Language	English
Publisher	Taylor & Francis
Publisher Date	2016-11-07
Access Restriction	Open
Subject Keyword	Severe asthma Monoclonal antibodies IgE IL-5 Inflammation Asthma control
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine

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Is IgE or eosinophils the key player in allergic asthma pathogenesis? Are we asking the right question?

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