Τίτλος:
Omalizumab as alternative to chronic use of oral corticosteroids in severe asthma
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Systemic/oral corticosteroids (OCS) have been used for decades in the management of acute asthma exacerbations and chronically in patients with uncontrolled severe asthma. However, while OCS are effective at treating acute exacerbations, there is only empirical evidence regarding the efficacy of OCS at reducing the rate of exacerbations. Evidence, although scarce, is suggestive of high exacerbation rates in severe asthma patients even when receiving maintenance treatment with OCS. In addition, use of OCS is associated with undesirable effects. Despite all this, physicians have continued to use OCS for managing severe asthma and acute exacerbation due to the lack of availability of effective alternatives. Fortunately, in the last decade several biologics have been proven safe and effective for patients with uncontrolled severe asthma. This has led to the Global Initiative for Asthma (GINA) recommending the use of biologics, instead of maintenance OCS, in patients with severe asthma (GINA Step 5). These include one biologic targeting immunoglobulin E (IgE) (omalizumab), and different biologics targeting interleukin-5 (IL-5), the IL-5 receptor (IL-5R) or IL-4 receptor α-unit (IL-4R α), including mepolizumab (subcutaneous), reslizumab (intravenous), benralizumab (subcutaneous) and dupilumab (subcutaneous). Omalizumab for the treatment of severe allergic asthma reduces exacerbations, irrespective of blood eosinophil levels. Anti-IL-5/IL-5R biologics are indicated in patients with severe eosinophilic asthma and repetitive exacerbations, irrespective of the presence or absence of allergy. Recently, an anti-IL4Rα biologic has been approved by the FDA for eosinophilic phenotype or oral corticosteroid-dependent asthma. Finally, physicians should consider using biologics as an alternative to chronic OCS therapy. © 2019 Elsevier Ltd
Συγγραφείς:
Katsaounou, P.
Buhl, R.
Brusselle, G.
Pfister, P.
Martínez, R.
Wahn, U.
Bousquet, J.
Περιοδικό:
Advances in Respiratory Medicine
Εκδότης:
W.B. Saunders Ltd
Λέξεις-κλειδιά:
benralizumab; corticosteroid; dupilumab; immunoglobulin E; interleukin 4 receptor alpha; interleukin 5; mepolizumab; omalizumab; reslizumab; antiasthmatic agent; benralizumab; biological product; corticosteroid; dupilumab; IL4R protein, human; IL5 protein, human; immunoglobulin E; interleukin 4 receptor alpha; interleukin 5; interleukin 5 receptor; mepolizumab; monoclonal antibody; omalizumab; reslizumab, allergic asthma; asthma; childhood disease; disease severity; drug targeting; drug use; human; maintenance therapy; practice guideline; priority journal; Review; asthma; drug effect; female; immunology; intravenous drug administration; male; oral drug administration; pathophysiology; severity of illness index; subcutaneous drug administration, Administration, Intravenous; Administration, Oral; Adrenal Cortex Hormones; Anti-Asthmatic Agents; Antibodies, Monoclonal, Humanized; Asthma; Biological Products; Female; Humans; Immunoglobulin E; Injections, Subcutaneous; Interleukin-4 Receptor alpha Subunit; Interleukin-5; Male; Omalizumab; Receptors, Interleukin-5; Severity of Illness Index
DOI:
10.1016/j.rmed.2019.02.003
