Severe refractory asthma: current treatment options and ongoing research

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Abstract

Patients with severe asthma have a greater risk of asthma-related symptoms, morbidities, and exacerbations. Moreover, healthcare costs of patients with severe refractory asthma are at least 80% higher than those with stable asthma, mainly because of a higher use of healthcare resources and chronic side effects of oral corticosteroids (OCS). The advent of new promising biologicals provides a unique therapeutic option that could achieve asthma control without OCS. However, the increasing number of available molecules poses a new challenge: the identification and selection of the most appropriate treatment. Thanks to a better understanding of the basic mechanisms of the disease and the use of predictive biomarkers, especially regarding the Th2-high endotype, it is now easier than before to tailor therapy and guide clinicians toward the most suitable therapeutic choice, thus reducing the number of uncontrolled patients and therapeutic failures. In this review, we will discuss the different biological options available for the treatment of severe refractory asthma, their mechanism of action, and the overlapping aspects of their usage in clinical practice. The availability of new molecules, specific for different molecular targets, is a key topic, especially when considering that the same targets are sometimes part of the same phenotype. The aim of this review is to help clarify these doubts, which may facilitate the clinical decision-making process and the achievement of the best possible outcomes.

Keywords: cytokines, economic burden, endotypes, eosinophils, inflammation, phenotypes.

Citation: Menzella F, Bertolini F, Biava M, Galeone C, Scelfo C, Caminati M. Severe refractory asthma: current treatment options and ongoing research. Drugs in Context 2018; 7: 212561. DOI: 10.7573/dic.212561

Contributions: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: Francesco Menzella participated in contracted research and clinical trials for Novartis and Sanofi, he has received lecture fees and advisory board fees from AstraZeneca, BoehringerIngelheim, Chiesi, GlaxoSmithKline, Mundipharma and Novartis. The other authors report no conflicts of interest in this work. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at https://www.drugsincontext.com/wp-content/uploads/2018/11/dic.212561-COI.pdf

Acknowledgments: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2018 Menzella F, Bertolini F, Biava M, Galeone C, Scelfo C, Caminati M. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2018 Menzella F, Bertolini F, Biava M, Galeone C, Scelfo C, Caminati M. https://doi.org/10.7573/dic.212561. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/severe-refractory-asthma-current-treatment-options-and-ongoing-research

Correspondence: Francesco Menzella, Department of Medical Specialties, Pneumology Unit, Azienda USL di Reggio Emilia, IRCCS, Viale Amendola 2, 42122 Reggio Emilia, Italy. francesco.menzella@ausl.re.it

Provenance: invited; externally peer reviewed.

Submitted: 26 September 2018; Peer review comments to author: 12 November 2018; Revised manuscript received: 14 November 2018; Accepted: 16 November 2018; Publication date: 5 December 2018.

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