Mepolizumab, an anti-interleukin 5 inhibitor has shown promising results in treating severe refractory asthma
Asthma affects an estimated 300 million people worldwide. The severity of asthma can vary from individual to individual. Most of the asthmatics get sufficient relief from the medications currently available. But rarely some individuals may have very severe asthma which is not amenable to treatment by standard medications available now. New drugs are being developed targeting this special population with poor asthma control.
Cytokines are inflammatory mediators that increase the airway inflammation, fluid accumulation (edema) and cause airway narrowing. Theoretically by inhibiting the cytokines, the airway inflammation and narrowing can be controlled. With this conceptual background several new drugs are being developed. Most of them are in clinical trials. Let us see an overview of these drugs.
| Drug | Action | Outcomes |
| Meplizumab | anti-IL5 | In severe refractory eosinophilic asthma, the frequency of exacerbation is reduced by 90%. The drug is well tolerated in the clinical trials. Large studies are needed to confirm its effectiveness. |
| Reslizumab | anti-IL5 | under trial |
| Enralizumab | anti-IL5 | under trial |
| Pitrakinra | anti-IL4/IL13 | Subcutaneous administration reduces asthma related adverse effects. Also reduces the magnitude of late asthmatic response. Can be delivered as an inhalational agent. |
| AMG317 | anti-IL4/IL13 | No change in the asthma symptoms but in a subgroup of severe asthmatics it improves certain efficiency parameters. The drug is well tolerated in initial studies. |
| Nuvance | anti-IL4 | No effect on asthma symptoms |
| Etanercept | anti-TNF alpha | Improves the FEV1 but abandoned due to adverse side effects including pneumonia, TB, sepsis and lymphoma |
| Infliximab | anti TNF alpha | Reduced asthma exacerbation but abandoned due to adverse side effects including pneumonia, TB, sepsis and lymphoma |
| Golimumab | anti TNF alpha | No effect on asthma symptoms but has several adverse side effects including pneumonia, TB, sepsis and lymphoma |
| AMG157 | anti-thymic stromal lymphopoietin | In phase 1 development. In animal models reduces eosinophilic inflammation of airways. |
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