Millions of people worldwide suffer from asthma, a chronic inflammatory disease of the lungs. Inhaled corticosteroids and bronchodilators help most patients get control of their asthma, but some people with severe asthma continue to have symptoms even after receiving the best care possible. For these people, a new age of targeted, efficient, and customized therapy choices has been brought about by the development of biologic treatments.
What are biologics?
“Monoclonal antibodies known as biologics are designed to specifically target molecules or cells that are implicated in the inflammatory processes of asthma. Biologics reduce airway inflammation and asthma symptoms with fewer systemic side effects than conventional drugs that generally lower inflammation. This is because they interfere with specific immunological signals,” answers Dr V Nagarjuna Maturu, Senior Consultant, Clinical and Interventional Pulmonology, Hyderabad.
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Biologic Types for Severe Asthma
For severe asthma, there are currently a number of authorized biologics that target different pathways:
- Omalizumab: Targeting immunoglobulin E (IgE), this first-approved biopharmaceutical effectively treats allergic asthma.
- Mepolizumab, Reslizumab, and Benralizumab: These medications lower eosinophil levels, which are frequently raised in severe eosinophilic asthma, by targeting interleukin-5 (IL-5) or its receptor.
- Dupilumab: Effective in treating type 2 inflammatory asthma, it inhibits the IL-4 and IL-13 pathways by blocking the IL-4 receptor alpha.
- Tezepelumab: Targeting the upstream mediator thymic stromal lymphopoietin (TSLP), tezepelumab is exceptional in its ability to treat a wide variety of severe asthma symptoms, even those without increased eosinophils or allergies.
Of the above biologics, currently only Omalizumab, Mepolizumab and Benralizumab are available in India.
Also Read: Here's How Heat Wave Worsens Your Asthma Symptoms
Impact on Clinical Practice
As per Dr V Nagarjuna Maturu, “Clinical research and real-world studies have shown that biologics offer substantial advantages. They enhance lung function, lower hospitalization rates, cut down on asthma flare-ups by around half, and enable many patients to cut back on or stop using oral corticosteroids, which have significant adverse effects. Crucially, these treatments for asthma enhance patients' quality of life when they have few other viable options.”
While using biologics, upto 50 percent of patients have complete relief from symptoms, asthma flare ups and need of oral steroids, and these people are known to have achieved ‘Clinical Remission’.
Patient Selection and Personalized Medicine Biologics work best when the treatment is tailored to the patient's asthma pheno-endotype, which is determined by indicators such blood eosinophil counts and IgE levels. Patients are certain to receive the therapy that will help them the most, and this is called Precision therapy or Personalized Medicine. Thanks to this individualized approach, the effectiveness is maximized.
Also Read: Top Tips To Manage Asthma During Summer Heatwaves
Accessibility and Safety of Biologics For Asthma Treatment
Injection site responses,and mild headaches are among the usual side effects of biologics, which are generally well tolerated. Biologics are only used for individuals with severe asthma that cannot be controlled with conventional medications, and access is usually regulated by specialty clinics.
In the treatment of severe asthma, biologics mark a paradigm change that gives patients with previously uncontrollable disease hope and better results. More accurate and efficient biologic treatments are expected as research progresses, which will further individualized asthma treatment, and improve patient outcomes.