Drug Design, Development and Therapy (Jun 2017)
Targeted therapy in severe asthma today: focus on immunoglobulin E
Abstract
Girolamo Pelaia,1 Giorgio Walter Canonica,2 Andrea Matucci,3 Rossella Paolini,4 Massimo Triggiani,5 Pierluigi Paggiaro6 1Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia of Catanzaro, Catanzaro, 2Personalized Medicine Asthma & Allergy Clinic, Humanitas University, IRCCS Humanitas Research Hospital, Rozzano-Milano, 3Immunoallergology Unit, AOU Careggi, Florence, 4Department of Molecular Medicine, “Sapienza” University of Rome, Laboratory affiliated to Istituto Pasteur Italia – Fondazione Cenci Bolognetti, Rome, 5Division of Allergy and Clinical Immunology, University of Salerno, Salerno, 6Cardio Thoracic and Vascular Department, Pathophysiology Unit, University of Pisa, Pisa, Italy Abstract: Asthma is a complex chronic inflammatory disease of multifactorial etiology. International guidelines increasingly recognize that a standard “one size fits all” approach is no longer an effective approach to achieve optimal treatment outcomes, and a number of disease phenotypes have been proposed for asthma, which has the potential to guide treatment decisions. Among the many asthma phenotypes, allergic asthma represents the widest and most easily recognized asthma phenotype, present in up to two-thirds of adults with asthma. Immunoglobulin E (IgE) production is the primary and key cause of allergic asthma leading to persistent symptoms, exacerbations and a poor quality of life. Therefore, limiting IgE activity upstream could stop the entire allergic inflammation cascade in IgE-mediated allergic asthma. The anti-IgE treatment omalizumab has an accepted place in the management of severe asthma (Global Initiative for Asthma [GINA] step 5) and represents the first (and, currently, only) targeted therapy with a specific target in severe allergic asthma. This review summarizes current knowledge of the mechanisms and pathogenesis of severe asthma, examines the actual role of IgE in asthma and the biological rationale for targeting IgE in allergic asthma and reviews the data for the efficacy and safety of omalizumab in the treatment of severe asthma. Current knowledge of the role of IgE in asthma, extensive clinical trial data and a decade of use in clinical practice has established omalizumab as a safe and effective targeted therapy for the treatment of patients with severe persistent IgE-mediated allergic asthma. Keywords: anti-immunoglobulin E, allergic asthma, Global Initiative for Asthma step 5 therapy, severe persistent asthma, omalizumab, phenotypes, targeted therapy
