The role of biologics in the management of asthma in the pediatric patient

The management of pediatric patients with asthma continues to be a major health issue. For many patients, traditional therapies have been very effective, but for a large number of patients asthma remains poorly controlled. This leads to significant morbidity and impairment to quality of life. Recently, several new biologics, as well as new dosage forms of combination inhaled drugs, have been made available for use adding to the armamentarium of therapy for specific asthma phenotypes. Biologics have shown promise in the more difficult to manage asthma patient. Approved in children, omalizumab, an anti–immunoglobulin E (anti-IgE) antibody, has been available for several years. New agents, like mepolizumab and benralizumab, directed against interleukin (IL) 5, have indications for children >6 and >12 years of age, respectively. Dupilumab, an IL-4– and IL-13–directed antibody, has been studied as well in eosinophilic asthma, with positive results. A thorough understanding of the clinical data of these agents is key, as they may greatly improve the quality of life in children with difficult-to-manage asthma. ABBREVIATIONS AAER, annual asthma exacerbation rate; BORA, Benralizumab in Asthmatic Adults and Adolescents on Inhaled Corticosteroids Plus Long-acting Beta₂-agonist; CALIMA, Benralizumab as Add-on Treatment for Patients With Severe, Uncontrolled, Eosinophilic Asthma; DREAM, Dose Ranging Efficacy and Safety With Mepolizumab in Severe Asthma; FDA, US Food and Drug Administration; FeNO, fractional exhaled nitric oxide; FEV₁, forced expiratory volume in 1 second (lung function); ICS, inhaled corticosteroid; Ig, immunoglobulin; IL, interleukin; IV, intravenous; LABA, long-acting beta₂-agonist; LIBERTY ASTHMA QUEST, Evaluation of Dupilumab in Patients With Persistent Asthma; LIBERTY ASTHMA VENTURE, Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma; MELTEMI, Benralizumab for Asthmatic Adults on Inhaled Corticosteroids Plus LABA; MENSA, Mepolizumab as Adjunctive Therapy in Patients With Severe Asthma; MUPPITS-2, Mepolizumab Adjunctive Therapy for the Prevention of Asthma Exacerbations in Urban Children; NO, nitric oxide; OCS, oral corticosteroid; SIRIUS, Steroid Reduction With Mepolizumab Study; SIROCCO, Benralizumab for Patients With Severe Asthma Uncontrolled With High-Dose Inhaled Corticosteroids and Long-acting Beta₂-agonists; SQ, subcutaneous; TARC, thymus and activation-regulated chemokine; ZONDA, Oral Glucocorticoid-Sparing Effect of Benralizumab in Severe Asthma.