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Recent Advances in Asthma Management

Recent Advances in Asthma Management

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Asthma affected an estimated 262 million people in 2019 and caused 455,000 deaths. It is categorised by chronic airway inflammation of the lungs, with associated respiratory symptoms including, shortness of breath, wheezing, cough and chest tightness.1,2 In recent years, there has been significant progress in understanding the pathophysiology and treatment of asthma. However, globally it remains a major cause of mortality and morbidity.3

World Asthma Day, on 2 May, is organised by the Global Initiative for Health (GINA) in collaboration with the World Health Organisation (WHO). The focus is to encourage respiratory communities across the world to work together in the development and implementation of effective asthma treatments.

Since the conception of World Asthma Day in 1998, there has been a shift in asthma treatment leading to a significant decrease in asthma mortality worldwide. Despite this improvement in mortality, asthma prevalence is increasing, and 8% of treated patients are still being classified as having severe asthma. These statistics highlight the need for ongoing research into the management of asthma and exploration of new treatments.

Worldwide, avoidable asthma deaths are attributed to inappropriate management of asthma, including overreliance on reliever medication rather than preventer medication.4 Effective asthma management would involve tackling modifiable risk factors, using a serial approach for the titration of inhaled pharmacotherapy and, in severe disease, consideration of biologic agents.3 Considering the global increase in the incidence of severe asthma, below are some biologic treatments for to keep an eye out for:

Tezepelumab is an anti-thymic stromal lymphopoietin monoclonal antibody that has been shown to reduce exacerbations and improve lung function and quality of life.5 This biologic agent is currently under further investigation and was developed by AstraZeneca and Amgen. At the end of 2022, it had been approved for treatment of asthma by the FDA, and has recently been approved in Japan for the treatment of moderate to severe asthma. It is thought that Tezepelumab provides a broad spectrum of inhibition of type-2 inflammation, suggesting that it could potentially be considered as a first line biologic regardless of the asthma phenotype.

Astegolimab is a monoclonal antibody that blocks IL-33 by targeting the IL-33 receptor.common triggers of asthma exacerbations, such as respiratory viruses or allergens, induce the synthesis and release of IL-33. This then activates T-helper (TH) 1 and TH2 cells leading to cytokine release. In a phase 2b trial, asteogolimab reduced asthma exacerbation rate in a wide spectrum of asthmatics.

Depemokimab is an anti-IL-5 monoclonal antibody (long acting) developed by GSK for the treatment of severe eosinophilic asthma. It has been designed to have an extended half-life and improved affinity for the cytokine IL-5. A phase 1 randomised control study has demonstrated an extended half life and prolonged reduction in blood eosinophils after a single dose. A phase III trial with adults and adolescent participants is currently underway assessing efficacy and safety in patients with severe, uncontrolled eosinophilic phenotype asthma.

This is a brief summary of three biologics for asthma that are in various drug development stages. They have the potential to reduce the number of exacerbations and hospitalisations, particularly for those with severe asthma. These new biologics may be available by the next World Asthma Day or perhaps, even included in new asthma guidelines.

References

  1. Sockrider M, Fussner L. What is asthma? Am J Respir Crit Care Med. 2020;202(9): P25-P26.
  2. Calzetta L, Aiello M, Frizzelli A, et al. Investigational treatments in phase I and II clinical trials: a systematic review in ashma. Biomedicines. 2022;10(9):2330.
  3. Witt A, Douglass JA, Harun NS. Overview of recent advancements in asthma management. Intern Med J. 2022;52(9):1478-1487.
  4. Global Asthma Network. The Global Asthma Report 2022. Available from URL: http://globalasthmareport.org/. Last accessed on June 10, 2023.
  5. Corren J, Parnes JR, Wang L, et al. Tezepelumab in adults with uncontrolled asthma [published correction appears in N Engl J Med. 2019 May 23;380(21):2082]. N Engl J Med. 2017;377(10):936-946.

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