Asthma is a chronic inflammatory disease of the airways produced by a complicated interaction of several biologic processes. For the treatment of severe eosinophilic asthma, many monoclonal antibody treatments targeting the interleukin (IL)-4/IL-13 and IL-5 cytokine pathways have been developed. Because people might have biomarkers and clinical characteristics associated with various asthma subtypes, selecting an optimum biologic can be difficult. Dupilumab, a monoclonal antibody that binds to the IL-4R subunit and has been authorised for the treatment of adults with severe atopic dermatitis, has been demonstrated in recent phase 3 trials to offer significant clinical improvements in the asthmatic population regardless of baseline eosinophil levels.
Because monoclonal antibodies targeting either IL-4 or IL-13 cytokines failed to exhibit substantial therapeutic advantages, biologics targeting cytokine receptors may be more effective than those targeting cytokines. Furthermore, blocking the IL-4/IL-13 signalling cascades may disrupt a wider Th2 inflammatory response as opposed to a more specific suppression of eosinophil growth and activity via the IL-5 route. Future research using independently financed, head-to-head trials of licenced biologics is required to identify a promising treatment alternative.