Asthma is generally controlled with an inhaled corticosteroid and beta2-agonist. However many patients can be steroid-resistant. The development of novel therapy can be boon for such patients. The recent development of a new class of biological agents that target airway type 2 inflammation has provided an opportunity for treating patients with corticosteroid refractory asthma.

Two new classes of novel therapeutics developed are:

  1. Anti-immunoglobulin [Ig]E
  2. Leukotriene inhibitors

Cytokines are proteins that play an important role in how cells communicate with each other. A large number of cytokines and growth factors have been detected in the airway in asthma, identifying which of these cytokines play an important role in disease pathogenesis in humans has proven to be challenging.

Both inflammatory cells in the airway, including T cells, mast cells, eosinophils, and macrophages, and structural cells in the airway, such as epithelium and smooth muscle cells, generate and respond to cytokine signals.

Targeting interleukin (IL)-4 is an example of an anti-cytokine approach that showed great promise in asthma initial phase 2 studies in asthma with therapy to neutralize IL-4 in asthma showed significant promise.

Currently there are five biologicals approved for difficult-to-control asthma,targeting IgE (omalizumab), IL-5( mepolizumab and reslizumab), IL-5alpha(benralizumab), and IL-4ralpha( dupilumab). These drugs were shown to have steroid-sparing effects and reduce asthma exacerbations, as well as hospital admissions, in randomized control trials.

( Reference European journal of allergy and clinical immunology, Medscape. The article is written solely for educational purposes.)