Dear friends please read interesting article: Severe asthma: anti-IgE or anti-IL-5? from European Clinical Respiratory Journal 2016!
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.
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