Identification and treatment of T2-low asthma in the era of biologics
- Chris Kyriakopoulos,
- Athena Gogali,
- Konstantinos Bartziokas and
- Konstantinos Kostikas⇑
- Dr. Konstantinos Kostikas, Respiratory Medicine Department, University of Ioannina School of Medicine, 45110 Ioannina, Greece. E-mail: ktkostikas{at}gmail.com
Abstract
Currently, and based on the development of relevant biologic therapies, T2-high is the most well-defined endotype of asthma. Although much progress has been made in elucidating T2-high inflammation pathways, no specific clinically applicable biomarkers for T2-low asthma have been identified. The therapeutic approach of T2-low asthma is a problem urgently needing solution, firstly because these patients have poor response to steroids, and secondly because they are not candidates for the newer targeted biologic agents. There is, thus, an unmet need for the identification of biomarkers that can help the diagnosis and endotyping of T2-low asthma
Ongoing investigation is focusing on neutrophilic airway inflammation mediators as therapeutic targets, including IL-8, IL-17, IL-1, IL-6, IL-23, TNF-a; molecules that target to restore corticosteroid sensitivity, mainly mitogen-activated protein kinase inhibitors, tyrosine kinase inhibitors and phosphatidylinositol 3-kinase inhibitors; PDE3 inhibitors that act as bronchodilators and PDE4 inhibitors that have an anti-inflammatory effect; and airway smooth muscle mass attenuation therapies, mainly for patients with paucigranulocytic inflammation
This manuscript aims to review the evidence for non-eosinophilic inflammation being a target for therapy in asthma, discuss current and potential future therapeutic approaches, such as novel molecules and biologic agents, and assess clinical trials of licensed drugs in the treatment of T2-low asthma.
Footnotes
This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Kyriakopoulos has nothing to disclose.
Conflict of interest: Dr. Gogali has nothing to disclose.
Conflict of interest: Dr. Bartziokas has nothing to disclose.
Conflict of interest: Dr. Kostikas has nothing to disclose.
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- Received May 25, 2020.
- Accepted September 8, 2020.
- Copyright ©ERS 2020
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