The underlying chronic inflammatory process and airway remodeling (AR) that occur in asthma contribute to the symptomatology of the disease. Today, the most severely ill asthma patients can be treated using a variety of monoclonal antibodies targeting key inflammatory cytokines involved in asthma pathogenesis. Although clinical data show much beneficial effects of biological therapies in terms of reduction of exacerbation rates, improvement of lung function, asthma control, and patients’ quality of life, little is known on the effects of these monoclonal antibodies on AR—a key clinical trait of long-term asthma management.

For a review published in Frontiers in Immunology, researchers summarized the data on the proven effects of monoclonal antibodies in asthma on AR. “To date, in terms of reversing AR, the most studied biological therapy has been omalizumab,” the study authors wrote. “However, some studies also addressed this clinical issue in context of other severe asthma biological therapies (mepolizumab, benralizumab, and tralokinumab). Still, data on the effects of particular biological therapies on AR in severe asthma are incomplete and require further research.”

  Need to Monitor AR in Clinical Studies is Critical

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According to the American Thoracic Society (ATS) 2017 expertise—and other researchers’ opinions–it should be further investigated whether biological therapy for asthma significantly affects AR, and if so, to what extent, as well as the clinical consequences of such an effect. Moreover, research on AR was indicated by ATS as crucial in the development of knowledge about asthma and its treatment. “The need to monitor AR in future clinical studies is an important aspect of response to modern biological treatment of severe asthma,” the study authors wrote. “These recommendations also highlight the need to study the impact of currently available biological preparations on AR and to look for new drugs that alleviate it.”

The development of biological therapies has opened a new chapter in treatment of severe asthma, the authors stated. Since introduction in 2004 of the first monoclonal antibody for this disease—the anti-IgE drug omalizumab—a new range of biology-oriented therapy emerged. “With the arrival of subsequent antibodies targeting other molecules involved in asthma pathophysiology, it became possible to treat the most severely ill patients using phenotype-oriented drugs,” researchers noted. “However, as only since recent years new drugs in this field arrive, little is known about their effect on the AR—a key clinical feature of severe asthma and its long-lasting consequences. The data available to date confirms with a high degree of probability only the beneficial role of omalizumab in reversing AR.”

The study authors concur that some promising studies cover this topic regarding mepolizumab and benralizumab. Yet, future research of available and upcoming biological therapies in severe asthma shall address this clinical issue as an important feature of long-term severe asthma management.