Search

Introduction: Severe asthma is a chronic respiratory condition that affects a significant number of individuals, causing persistent inflammation of the airways and leading to recurrent symptoms such as wheezing, coughing, and shortness of breath. While conventional asthma treatments, including inhaled corticosteroids and bronchodilators, are generally effective for most asthma patients, they may not always provide sufficient relief for individuals with severe asthma. In such cases, the use of biologic agents licensed specifically for severe asthma can be a valuable treatment option. Aim of the study: This article aims to explore the different biologic agents licensed for severe asthma and delve into their effectiveness in managing this complex and challenging condition. Material and methods: Literature available in the PubMed database was reviewed using the following keywords: biologic agents for asthma; omalizumab; mepolizumab; bernalizumab; tezepelumab; monoclonal antibodies. Conclusions: These medications are designed to target the underlying mechanisms of severe asthma, addressing the root causes of the condition rather than just managing the symptoms. As a result, they have shown promising results in improving symptoms and reducing exacerbations in individuals with severe asthma. By understanding the potential benefits of these medications, healthcare professionals can make informed decisions when it comes to treating patients with severe asthma.

Antecedentes: El manejo del asma grave eosinofílica incluye tipificación para identificar fenotipos alérgicos, eosinofílicos y no TH2. Niveles elevados de eosinófilos se asocia a mayor nivel de IL-5. Los eosinófilos durante su migración a los tejidos diana, secretan proteínas que dañan el epitelio bronquial activado y se correlacionan con la gravedad del asma. Mepolizumab, anticuerpo monoclonal humanizado que se une y neutraliza la IL-5. Objetivos: Describir experiencia con el uso de biológico anti-interleucina 5 Mepolizumab. Métodos: Reporte de casos, estudio descriptivo. Se incluyeron pacientes con asma grave descontrolada, antecedente de Rinosinusitis con poliposis nasal y/o EREA. Eosinófilos ≥150 células/μL, FeNO ≥25 ppb y espirometría con patrón obstructivo. Resultados: Se incluyeron 6 pacientes mujeres con diagnóstico de Asma grave. Valores iniciales de eosinófilos de 180 – 630 cél/μL, IgE 176 – 2500 Ui/ml, FENO 23 -39, ACT a los 2, 4 y 6 meses de uso, mínima de 9 y final máxima de 25. Mejoría considerable en la prueba ACT desde los primeros dos meses de uso, disminucion de esteroide inhalado y 0 a 2 exacerbaciones en 6 meses. Conclusión: Existen múltiples estudios, no se cuenta con reportes estadísticamente significativos para demostrar superioridad con el uso de algún biológico en específico, aunado a las diferentes limitantes económicas que existen en el país. Es necesario identificar poblaciones objetivo con los fenotipos que responderán a una terapia específica y dirigir el tratamiento. En México hay pocos centros hospitalarios con estas terapias, es necesario continuar con la evaluación constante y aporte de información para poder encontrar el tratamiento idóneo para la población mexicana.

Resumen: Introducción: El mepolizumab es un anticuerpo monoclonal que bloquea la interleuquina 5 circulante (IL5). El benralizumab se une a la subunidad alfa del receptor de la IL 5 induciendo la eliminación directa de eosinófilos y basófilos. El propósito fue evaluar su efectividad en nuestra práctica clínica habitual. Métodos: Estudio observacional retrospectivo de una cohorte de pacientes asmáticos graves eosinofílicos tratados con mepolizumab y benralizumab durante al menos 6 meses. El seguimiento se ha realizado en la unidad de asma. Resultados: Se analizaron 25 pacientes en tratamiento con mepolizumab y 13 con benralizumab alcanzando un tiempo de seguimiento de 12 meses en el 73,7% de los mismos (10 en el caso de benralizumab y 18 para mepolizumab). Tras el tratamiento biológico se observa una disminución del 71% en el número de ingresos (p = 0,0027) y del 66% (p = 0,0013) en las visitas a urgencias. Se contabilizaron 31 ciclos de corticoides vs. 15 tras el tratamiento biológico suponiendo un descenso de un 52% (p = 0,0069). El control del asma medido por cuestionario de control (ACT) fue de 10,8 puntos (SD: 4,73) vs. 20,3 puntos (SD: 4,77), (p = 0,001) y el % FEV1 fue del 70,6% (SD: 21.5) vs. 76,2% (SD: 27,2), (p = 0,0437). Conclusiones: Se confirma la efectividad de los fármacos anti-IL5 en vida real mostrando mejoras en exacerbaciones, control y función pulmonar. Abstract: Introduction: Mepolizumab is a monoclonal antibody that inhibits circulating interleukin 5 (IL-5). Benralizumab binds to the alpha subunit of the IL-5 receptor, inducing the direct elimination of eosinophils and basophils. The aim of this study was to evaluate their effectiveness in our routine clinical practice. Methods: A retrospective observational study of a cohort of patients with severe eosinophilic asthma treated with mepolizumab and benralizumab for at least 6 months, and followed up in the asthma unit. Results: We analyzed 25 patients who received mepolizumab and 13 who received benralizumab, 73.7% of whom were followed up for 12 months (10 months for benralizumab and 18 for mepolizumab). After biological treatment, there was a 71% reduction in the number of admissions (p = .0027) and a 66% reduction (p = .0013) in emergency visits. A reduction in corticosteroid use was recorded: 31 cycles of corticosteroids compared to 15 after biological treatment, representing a decrease of 52% (p = .0069). Asthma control measured by the Asthma Control Test was 10.8 (SD: 4.73) vs. 20.3 (SD: 4.77), (p = .001) and FEV1% was 70.6% (SD: 21.5) vs. 76.2% (SD: 27.2), (p = .0437). Conclusions: The effectiveness of anti-IL-5 drugs in real life was confirmed, with improvements in exacerbations, asthma control and lung function.

El asma grave es una enfermedad heterogénea y compleja que afecta aproximadamente al 5% de los pacientes con asma y se asocia a una importante carga de síntomas, exacerbaciones graves frecuentes e impactos negativos en la funcionalidad y calidad de vida. Diferentes estrategias de innovación han actualizado las opciones terapéuticas disponibles para estos pacientes, pero los anticuerpos monoclonales representan las alternativas con mayor relevancia clínica. Como especialistas en asma es importante mantenernos actualizados para poder identificar correctamente a aquellos pacientes que pueden beneficiarse del tratamiento con estos medicamentos. Este artículo ofrece una revisión actualizada y práctica enfocada en mepolizumab, un anticuerpo monoclonal humanizado anti-IL5 aprobado como tratamiento complementario en pacientes con asma grave eosinofílica. Los autores hemos realizado una síntesis de las evidencias de eficacia, seguridad y efectividad de mepolizumab con el objetivo de proveer una herramienta de consulta y apoyo en la toma de decisiones para el especialista que evalúa, diagnostica y trata pacientes con asma grave. Mepolizumab ha documentado en condiciones controladas de ensayos clínicos, y en estudios de vida real reducir consistente y significativamente las exacerbaciones de asma, mejorar el control de la enfermedad, mejorar la calidad de vida de los pacientes, y disminuir la dosis o retirar la exposición a corticoesteroides sistémicos.

Los objetivos del tratamiento de la aspergilosis broncopulmonar alérgica (ABPA) son la reducción de la inflamación pulmonar, el control del asma, el tratamiento del estadio agudo de ABPA, prevenir las exacerbaciones, evitar la apari- ción o progresión a la bronquiectasia y la aspergilosis pulmonar crónica. El tratamiento utilizado hasta la actualidad han sido corticoides a largo plazo, azoles y LABA/CI. En pacientes graves sin respuesta al tratamiento con corticoides ora- les y antifúngico recientemente se han utilizado otros tratamientos como omalizumab y antiIL5 (mepolizumab).

Despite promising advancements in oral immunotherapy for food allergies, medical implementation faces limitations. Non-specific treatment options based on inhibiting the type 2 inflammatory pathway, including monoclonal antibodies, are under investigation. TNX-901 and omalizumab have demonstrated increased reaction thresholds, reducing adverse events in peanut-allergic patients. Dupilumab, blocking the IL-4 receptor, shows positive results in both food allergies and eosinophilic esophagitis. Antibodies against alarmins and anti-IL-5, such as etokimab and mepolizumab, have proven efficacy in preclinical studies and clinical trials. While further studies are needed to establish their practical clinical use and determine suitability for different types of food allergies, these monoclonal antibodies present a promising horizon for the treatment of such conditions.

Background: Management of severe eosinophilic asthma includes typing to identify allergic, eosinophilic and non-HT2 phenotypes. Elevated eosinophil levels are associated with higher IL-5 levels. Eosinophils during their migration to target tissues secrete proteins that damage the activated bronchial epithelium and correlate with asthma severity. Mepolizumab, a humanized monoclonal antibody that binds and neutralizes IL-5., Objectives: To describe experience with the use of biological anti interleukin 5 Mepolizumab. Methods: Case report, descriptive study. We included patients with severe uncontrolled asthma, a history of rhinosinusitis with nasal polyposis and/or EREA. Eosinophils 150 cells/μL, FeNO 25 ppb and spirometry with obstructive pattern., Results: 6 women with a diagnosis of severe asthma were included. Initial eosinophil values of 180 - 630 cél/μL, IgE 176 - 2500 Ui/ml, FENO 23 -39, ACT at 2, 4 and 6 months of use, minimum of 9 and maximum end of 25. Significant improvement in the ACT test from the first two months of use, decreased inhaled steroid and 0 to 2 exacerbations in 6 months., Conclusions: There are multiple studies, there are no statistically significant reports to demonstrate superiority with the use of a specific biological, together with the different economic limitations that exist in the country. It is necessary to identify target populations with phenotypes In Mexico there are few hospitals with these therapies, it is necessary to continue with the constant evaluation and contribution of information to find the right treatment for the Mexican population. that will respond to a specific therapy and direct treatment., (Este obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.)

The management of severe uncontrolled asthma with biologics is an area of extreme difficulty given the scarcity of information regarding their starting criteria, the variables to be evaluated to determine the efficacy and safety of their management, the cut-off points to determine the timing to change or add another biological and the process to decrease or withdraw steroids. This review incorporates the latest information and makes a proposal based on it., (© 2022 Revista Medica del Instituto Mexicano del Seguro Social.)

Introduction: Mepolizumab is a monoclonal antibody that inhibits circulating interleukin 5 (IL-5). Benralizumab binds to the alpha subunit of the IL-5 receptor, inducing the direct elimination of eosinophils and basophils. The aim of this study was to evaluate their effectiveness in our routine clinical practice., Methods: A retrospective observational study of a cohort of patients with severe eosinophilic asthma treated with mepolizumab and benralizumab for at least 6 months, and followed up in the asthma unit., Results: We analyzed 25 patients who received mepolizumab and 13 who received benralizumab, 73.7% of whom were followed up for 12 months (10 months for benralizumab and 18 for mepolizumab). After biological treatment, there was a 71% reduction in the number of admissions (p = .0027) and a 66% reduction (p = .0013) in emergency visits. A reduction in corticosteroid use was recorded: 31 cycles of corticosteroids compared to 15 after biological treatment, representing a decrease of 52% (p = .0069). Asthma control measured by the Asthma Control Test was 10.8 (SD: 4.73) vs. 20.3 (SD: 4.77), (p = .001) and FEV 1 % was 70.6% (SD: 21.5) vs. 76.2% (SD: 27.2), (p = .0437)., Conclusions: The effectiveness of anti-IL-5 drugs in real life was confirmed, with improvements in exacerbations, asthma control and lung function., (© 2021 Sociedad Española de Neumología y Cirugía Torácica (SEPAR). Published by Elsevier España, S.L.U.)