Reslizumab: Maintenance treatment for eosinophilic asthma inadequately controlled on corticosteroids

The starting point for this drug was the growing realization that eosinophils appeared to be associated with a severe form of asthma in which patients were subject to exacerbations of their condition that could not be adequately managed using inhaled and/or oral corticosteroids. Studies of the pathophysiology of eosinophils revealed that they produce many bioactive compounds that contribute to the pathophysiology of a number of diseases including asthma. Interleukin-5 (IL-5) in particular is an important factor in some forms of severe asthma. A rat antibody to IL-5 (39D10) was humanized producing the product now know as reslizumab. However, initial studies of this antibody in patients with asthma were unsuccessful. It was only when the importance of the eosinophilic asthma endotype was recognized that reslizumab was found to indeed reduce the severity and exacerbations of asthma in patients who were inadequately treated by inhaled and/ or oral corticosteroids. These studies have determined that reslizumab is a valuable drug for the management of such patients provided that they have an eosinophil count of > 400 cells/mcL. Because a very small percentage of patients receiving reslizumab may experience anaphylaxis, reslizumab must be only given in a facility with adequate facilities and by a health professional trained in the management of anaphylaxis.

The efficacy and safety of reslizumab for inadequately controlled asthma with elevated blood eosinophil counts: A systematic review and meta-analysis

CONTEXT

Reslizumab is a humanised anti-interleukin 5 monoclonal antibody that disrupts eosinophil maturation and promotes programmed cell death.

OBJECTIVE

We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug in patients with inadequately controlled, eosinophilic asthma.

DATA SOURCES

The search included the following databases: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register.

STUDY SELECTION

A literature review was performed to identify all published randomized double-blind, placebo-controlled trials of reslizumab for the treatment of inadequately controlled, eosinophilic asthma.

DATA EXTRACTION

Two reviewers independently extracted and verified pre-defined data fields.

RESULTS

Four publications including 5 RCTs that compared reslizumab with placebo. For the comparison of reslizumab with placebo, asthma exacerbation (odds ratio (OR) = 0.46, 95% confidence interval (CI) = 0.35 to 0.59, p <0.00001); a forced expiratory volume in 1 s (FEV1) (the standardized mean difference (SMD) = 0.16, 95%CI = 0.10 to 0.23, p <0.00001); Asthma Control Questionnaire (ACQ) score (the SMD = -0.26, 95%CI= -0.36 to -0.16, p <0.00001); blood eosinophil counts (the SMD = -475.62, 95%CI = -528.41 to -422.83, p <0.00001). Safety assessments included the proportion of individuals who withdrawn due to adverse event (AE) (OR = 0.60 95%CI = 0.38 to 1.17, p = 0.16) indicated that reslizumab was well tolerated.

LIMITATIONS

The article didn't research the safety, efficacy of reslizumab with longer term.

CONCLUSIONS

This meta-analysis indicates that reslizumab to be an effective and safe treatment for inadequately controlled, eosinophilic asthma.

Biologic therapies targeting eosinophils: current status and future prospects

The recent explosion in the number of biologic therapies in clinical development for the treatment of eosinophilic disorders is unprecedented. As these agents become available for clinical use, the selection of the most appropriate agent for a given patient will become increasingly complicated. The aims of this review were 2-fold: (1) to present the lessons learned from clinical trials using the first generation of eosinophil-targeted biologics (anti-IL-5 antibodies) and (2) to discuss the advantages and potential limitations of currently available and novel targeted therapies to treat eosinophilic disorders.

Anti-IL5 therapy for asthma and beyond

Airway inflammation is considered to be the primary component contributing to the heterogeneity and severity of airway disorders. Therapeutic efficacies of diverse novel biologics targeting the inflammatory pathways are under investigation. One such target is IL-5, a type-1 cytokine that is central to the initiation and sustenance of eosinophilic airway inflammation. Over the past decade, anti-IL5 molecules have been documented to have mixed therapeutic benefits in asthmatics. Post hoc analyses of the trials reiterate the importance of identifying the IL-5-responsive patient endotypes. In fact, the currently available anti-IL5 treatments are being considered beyond asthma management; especially in clinical complications with an underlying eosinophilic pathobiology such as hypereosinophilic syndrome (HES) and eosinophilic granulomatosis and polyangitis (EGPA). In addition, closer analyses of the available data indicate alternative mechanisms of tissue eosinophilia that remain uncurbed with the current dosage and delivery platform of the anti-IL5 molecules.