In this second of a 2-part podcast on management of uncontrolled asthma, Dr Samuel Louie of the University of California, Davis, reviews the available targeted therapies that address the underlying pathways that cause airflow obstruction and may result in poorly controlled astha. Claim your credit at pce.is/ua.
Targeted therapies address the underlying pathways that cause airflow obstruction in patients with asthma, including a number of biologic therapies that have been approved. Omalizumab targets IgE (approved for moderate to severe persistent asthma). Three agents target IL-5, which plays a key role in the activation of eosinophils, and are approved for severe eosinophilic asthma: mepolizumab, reslizumab, and benralizumab. Dupilumab targets IL-4/13 and has been approved for moderate to severe eosinophilic asthma or patients requiring maintenance OCS. All agents are available as subcutaneous injections administered at specific intervals, with the exception of reslizumab, which is available as an intravenous infusion. Selection of which biologic agent to use is dependent on multiple factors, including cost, dosing frequency, delivery route, and patient preference among other considerations. The GINA guidelines suggest a biologic agent should be given a trial of at least 4 months; if treatment response is unclear, clinicians should consider extending the trial another 6 to 12 months. If no response is noted, therapy should be changed to another biologic agent. These biologic therapies are generally safe and well tolerated; however, primary care clinicians seeing patients with asthma must be knowledgeable about common adverse events in order to recognize them.
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Contributors:
Lawrence Herman, DMSc, MPA, PA-C
Adjunct Faculty
Doctor of Medical Science Program
University of Lynchburg School of PA Medicine
Lynchburg, Virginia
President
Palantir Healthcare, LLC
Boiling Springs, South Carolina
Samuel Louie, MD
Professor Emeritus
Division of Pulmonary and Critical Care Medicine
University of California, Davis
Davis, California