Biological treatments for severe asthma: where do we stand?

Purpose of review For patients with severe asthma, disease control is not achieved resulting in persistent morbidity and risks for exacerbations. The advent of biologics is providing a new form of treatment for many with severe asthma. Recent findings Four mAb biologics are approved for clinical use: omalizumab (anti-IgE) and three antieosinophilic interventions (mepolizumab, reslizumab, and benralizumab). These four biologics target components of the type 2-inflammatory pathway which is reflected by biomarkers: peripheral blood eosinophils and exhaled nitric oxide. In severe asthma, biologics have reduced asthma exacerbations. The antieosinophilic biologics have also improved lung function. The safety profile of these biologics has been good. Summary For patients with severe asthma and biomarkers indicating a type 2 inflammatory pathway, the addition of biologics has proven to be an effective approach to achieve disease control and is an appropriate next step treatment. Correspondence to William W. Busse, MD, Professor of Medicine, University of Wisconsin Hospitals and Clinics, 600 Highland Avenue, Madison, WI 53792, USA. E-mail: wwb@medicine.wisc.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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