Biologics in Asthma—The Next Step Toward Personalized Treatment

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Presentation transcript:

Biologics in Asthma—The Next Step Toward Personalized Treatment Jared Darveaux, MD, William W. Busse, MD The Journal of Allergy and Clinical Immunology: In Practice Volume 3, Issue 2, Pages 152-160 (March 2015) DOI: 10.1016/j.jaip.2014.09.014 Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 1 Pathobiology of asthma. Asthma originates from complex interactions between genetic factors and environmental agents such as aeroallergens and respiratory viruses. In particular, within the airway lumen, allergens can be taken up by dendritic cells, which process antigenic molecules and present them to naive T-helper (Th0) cells. The consequent activation of allergen-specific Th2 cells is responsible for the production of multiple cytokines and chemokines producing an allergic response. Adapted from Ref. 3. The Journal of Allergy and Clinical Immunology: In Practice 2015 3, 152-160DOI: (10.1016/j.jaip.2014.09.014) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 2 The seasonal variation in the percent of patients with asthma exacerbations and a comparison of guideline-directed care versus guideline-directed care plus omalizumab. Adapted from Ref. 17. The Journal of Allergy and Clinical Immunology: In Practice 2015 3, 152-160DOI: (10.1016/j.jaip.2014.09.014) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 3 Mean percent reduction (95% CI) in protocol-defined asthma exacerbation rate in the low- and high-biomarker subgroups (baseline fractional exhaled nitric oxide [FENO], peripheral blood eosinophils, and serum periostin). *Exacerbation reduction P values; omalizumab vs placebo in each biomarker subgroup. CI, confidence interval.19 The Journal of Allergy and Clinical Immunology: In Practice 2015 3, 152-160DOI: (10.1016/j.jaip.2014.09.014) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 4 Mepolizumab and exacerbations of refractory eosinophilic asthma. The cumulative number of severe exacerbations that occurred in each study group over the course of 50 weeks. Adapted from Ref. 40. The Journal of Allergy and Clinical Immunology: In Practice 2015 3, 152-160DOI: (10.1016/j.jaip.2014.09.014) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 5 Relative change in forced expiratory volume in 1 second (FEV1) in the intention-to-treat population. The Journal of Allergy and Clinical Immunology: In Practice 2015 3, 152-160DOI: (10.1016/j.jaip.2014.09.014) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Figure 6 Individualized management for asthma. If control is not achieved with ERP3 steps 1-3, the assessment of asthma phenotype should guide selection of the most likely effective biological agent. The Journal of Allergy and Clinical Immunology: In Practice 2015 3, 152-160DOI: (10.1016/j.jaip.2014.09.014) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions