Current State and Future of Biologic Therapies in the Treatment of Asthma in Children

Abstract

There is increasing recognition of phenotypic variability in pediatric asthma, providing the opportunity for a more personalized approach to therapy. Increasingly biologic therapies, in particular those targeting the "allergic" (or T helper 2) pathway, are being considered for children with severe asthma. However, there is a great deal of variability in the extent these biologic therapies have been studied in children, as well as efficacy of results thus far. The goal of this article is to review the mechanism of action, efficacy, and potential predictive and monitoring biomarkers of the biologic medications focusing on the pediatric population, in an effort to establish a more personalized approach to asthma in the pediatric population for the 21st century.

Keywords: asthma; asthma biomarkers; asthma medications; biologic therapies.

FIG. 1.

Relative risk reduction of exacerbations with biologic therapies in phase 2B*/3 studies. Adapted with permission from Lacy P and Nair P, in The human eosinophil. Wintrobe's Clinical Hematology (14th ed). Eds Greer JP, Arber DA, Glader B, Lost AF, Means RT, Paraskevas F, Rogers GM, Foerster J. Lippincott Williams & Wilkins, Philadelphia, PA, 2018 (in press).

FIG. 2.

Decrease in exacerbation rate (%) with omalizumab compared with placebo. Calculated as [placebo exacerbation rate—omalizumab exacerbation rate]/placebo exacerbation rate × 100.