The use of biologic therapies for the management of pediatric asthma

Abstract

With better understanding of the role of type 2 inflammation in allergic asthma, there has been progress made in the development of new biologic therapies targeting these specific pathways. This review will consider diagnostic criteria for using biologic therapies for pediatric asthma with special emphasis on populations that are likely to benefit the most from particular therapies. With the exception of the anti-immunoglobulin E, omalizumab, very few studies have been published on the efficacy and safety of biologic therapies in children, particularly anti-interleukin-5 (IL5) and anti-IL4/IL13 therapies. The review will highlight the scarcity of published data in pediatric-specific populations. In addition, we will consider the cost-effectiveness as well as potential long-term consequences of biologic therapies in pediatric asthma.

Keywords: T-helper 2 asthma; anti-IgE therapy; anti-eosinophil therapy; childhood asthma; monoclonal antibodies.

Figure 1:

Evidence of safety and efficacy of biologic therapies in pediatric asthma is sparse. The green bars represent the total number of participants enrolled in Phase 3 clinical trials for each respective therapeutic and the blue bars represent the number of children age 12-17 years (age 6-12 years for Omalizumab) that were enrolled.

Figure 2:

Enrollment of children in studies of biologic therapies in pediatric asthma is sparse. Table represents the total number of clinical trials currently registered on ClinicalTrials.gov for each of the biologic asthma therapies that are currently approved for use in children. All studies are represented by green bars and studies that have proposed to enroll children < 18 years are in blue.

Figure 3:

Considerations for selecting a biologic therapy in children younger than 18 years of age. Orange lines represent options for children 6-11 years and green lines represent options for children ≥ 12 years.