Treatment Challenges in Severe Eosinophilic Asthma: Differential Response to Anti-IL-5 and Anti-IL-5R Therapy

Severe asthma greatly affects patients' quality of life. Major advances have occurred in the management of severe eosinophilic asthma the past few years due to the new targeted biological therapies. There are three anti-IL-5 mAbs, mepolizumab, reslizumab and benralizumab. Despite the different mechanism of blocking IL-5 the clinical effects are quite similar as randomized controlled trials and real-life studies have shown. Moreover, there are reports of responding to one after failing to respond to another anti-IL-5 therapy. Accordingly, it is challenging to explore the possible differences in the response to anti-IL-5 treatments. This might help us not only understand possible mechanisms that contribute to the resistance to treatment in this particular asthma endotype, but also to phenotype within severe eosinophilic asthma in order to treat our patients more efficiently.

Automated summary

Major advances have been made in the management of severe eosinophilic asthma through new targeted biological therapies, with three anti-IL-5 monoclonal antibodies showing similar clinical effects despite different mechanisms. There are reports of patients responding to one anti-IL-5 therapy after failing to respond to another, challenging the exploration of potential differences in response to these treatments. This exploration may not only help understand mechanisms contributing to treatment resistance in this specific asthma endotype, but also aid in phenotyping severe eosinophilic asthma for more efficient patient treatment.