Increasing confidence in the therapeutic relevance of eosinophils in severe asthma

Abstract

Chronic airways diseases are a major burden globally, affecting all age groups and causing substantial morbidity, disability, and mortality worldwide. 1 Reddel HK Bateman ED Becker A et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015; 46: 622-639 Crossref PubMed Scopus (570) Google Scholar , 2 Vogelmeier CF Criner GJ Martinez FJ et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Eur Respir J. 2017; 49: 1700214 Crossref PubMed Scopus (496) Google Scholar In view of this challenging situation, the Lancet Commission After asthma: redefining airways diseases, chaired by Ian Pavord and Andrew Bush, proposes a major change in thinking about asthma that is generalisable to all airways diseases: the deconstruction of airways diseases into component parts that are identifiable and treatable. 3 Pavord ID Beasley R Agusti A et al. After asthma: redefining airways diseases. Lancet. 2017; (published online Sept 11.)http://dx.doi.org/10.1016/S0140-6736(17)30879-6 Summary Full Text Full Text PDF Scopus (571) Google Scholar , 4 Agusti A Bel E Thomas M et al. Treatable traits: toward precision medicine of chronic airway diseases. Eur Respir J. 2016; 47: 410-419 Crossref PubMed Scopus (589) Google Scholar Thus, identification of treatable traits would be the basis for future development of precision medicine for airways diseases. In that context, a study published in The Lancet Respiratory Medicine offers a timely addition to the literature in the form of a pooled analysis of two large randomised controlled trials of benralizumab, an anti-interleukin 5 receptor α monoclonal antibody, in patients with severe uncontrolled asthma. 5 FitzGerald JM Bleecker ER Menzies-Gow A et al. Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studies. Lancet Respir Med. 2017; (published online Sept 11.)http://dx.doi.org/10.1016/S2213-2600(17)30344-2 Summary Full Text Full Text PDF Scopus (167) Google Scholar In this Article, J Mark FitzGerald and colleagues report that improvements in asthma exacerbation rates were more pronounced in patients with a combination of higher blood eosinophil counts and a history of more frequent exacerbations. 5 FitzGerald JM Bleecker ER Menzies-Gow A et al. Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studies. Lancet Respir Med. 2017; (published online Sept 11.)http://dx.doi.org/10.1016/S2213-2600(17)30344-2 Summary Full Text Full Text PDF Scopus (167) Google Scholar These data support the ability of blood eosinophil count, a widely available and simple to use biomarker, to deliver precision medicine in patients with severe asthma. 3 Pavord ID Beasley R Agusti A et al. After asthma: redefining airways diseases. Lancet. 2017; (published online Sept 11.)http://dx.doi.org/10.1016/S0140-6736(17)30879-6 Summary Full Text Full Text PDF Scopus (571) Google Scholar , 4 Agusti A Bel E Thomas M et al. Treatable traits: toward precision medicine of chronic airway diseases. Eur Respir J. 2016; 47: 410-419 Crossref PubMed Scopus (589) Google Scholar , 5 FitzGerald JM Bleecker ER Menzies-Gow A et al. Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studies. Lancet Respir Med. 2017; (published online Sept 11.)http://dx.doi.org/10.1016/S2213-2600(17)30344-2 Summary Full Text Full Text PDF Scopus (167) Google Scholar Notably, this pooled analysis shows that the effects of benralizumab were consistent across a wide range of blood eosinophil counts. 5 FitzGerald JM Bleecker ER Menzies-Gow A et al. Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studies. Lancet Respir Med. 2017; (published online Sept 11.)http://dx.doi.org/10.1016/S2213-2600(17)30344-2 Summary Full Text Full Text PDF Scopus (167) Google Scholar This study also underscores the importance of additional features, including greater eosinophil count, history of exacerbations, oral corticosteroid use, and nasal polyposis, increasing confidence in the relevance of the eosinophilic phenotype with respect to predicting the possible benefits of benralizumab therapy. 5 FitzGerald JM Bleecker ER Menzies-Gow A et al. Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studies. Lancet Respir Med. 2017; (published online Sept 11.)http://dx.doi.org/10.1016/S2213-2600(17)30344-2 Summary Full Text Full Text PDF Scopus (167) Google Scholar Well-defined predictors of improved response to benralizumab will be of great interest to support precision medicine in severe asthma. Predictors of enhanced response with benralizumab for patients with severe asthma: pooled analysis of the SIROCCO and CALIMA studiesThese results will help to guide clinicians when they are deciding whether to use benralizumab to treat patients with severe, uncontrolled, eosinophilic asthma. Full-Text PDF