T2-associated diseases: focus on the comorbid patient

Abstract

T2-associated diseases are a group of heterogeneous immune-mediated diseases such as bronchial asthma (BA), chronic rhinosinusitis with nasal polyps (CRSwNP), atopic dermatitis (AD), based common pathogenetic mechanisms with the type 2 immune response (T2 inflammation). Interleukins 4 and 13 (IL-4, IL-13) play a key role in T2 inflammation, activating multiple mediators and types of cell, participating in the differentiation of T-lymphocytes and switching B-lymphocytes to the production of specific immunoglobulin E (IgE), promote migration eosinophils in tissue and airway remodeling. Taking into account pathogenesis of the T2-related diseases and presence of comorbid diseases is a strategically important goal for the optimal targeted therapy. The article discusses the contemporary terminology of T2 inflammation, key cytokines involved in the pathogenesis of atopic diseases, biomarkers of T2 inflammation as criteria for proving T2 inflammation, the place of anti-IL-4/IL-13 targeted biological therapy in international Guidelines for the treatment of severe BA GINA 2020 and EACCI 2020 recommendations, the effect of dupilumab on such clinically significant outcomes as a decrease in the frequency of severe exacerbations and an improvement in lung function, a decrease in the need for oral glucocorticosteroids (GCS) in patients with BA, the evidence base for dupilumab in patients with CRSwNP and AD, as well as further promising research directions for use antiIL-4/IL-13 targeted therapy.