Ronald Strauss, AAAAI 2023: Unmet needs in the treatment of severe eosinophilic asthma

Eosinophilic asthma is a severe subtype of asthma that usually starts in adulthood. It was a pleasure to talk with Dr Ronald Strauss (Case Western Reserve University; Cleveland Allergy and Asthma Center, Cleveland, OH, USA), a valued member of our Editorial Board for touchREVIEWS in Respiratory & Pulmonary Diseases, about the unmet needs in the treatment of severe eosinophilic asthma, and the factors that should be considered when deciding which drug to prescribe for severe eosinophilic asthma.

The abstract ‘Asthmatic super responders treated with mepolizumab up to six years‘ (Abstract number: 065) was presented at AAAAI 2023, February 24–27, 2022, #AAAAI2023.

Access an interview with Dr Ronald Strauss on the efficacy of mepolizumab in patients with severe eosinophilic asthma

Questions

1. Could you tell us a little about severe eosinophilic asthma and the unmet needs in its treatment? (0:22)
2. What factors should be considered when deciding which drug to prescribe for severe eosinophilic asthma? (1:29)

Disclosures: Ronald Strauss has nothing to disclose in relation to this video.

Support: Interview and filming supported by Touch Medical Media Ltd. Interview conducted by Atiya Henry.

Filmed in coverage of the American Academy of Allergy Asthma & Immunology Annual Meeting 2023.

Transcript:

Hi, this is Dr Ronald Strauss. I’m a Clinical Assistant Professor at Case Western Reserve and in private practice running the Cleveland Allergy and Asthma Center, which specializes in taking care of severe asthmatics.

Could you tell us a little about severe eosinophilic asthma and the unmet needs in its treatment? (0:22)

Severe eosinophilic asthma is a disease where there is a significant number of eosinophils, which accumulate in the bronchial tubes where they release cytotoxic proteins, lipid mediators, cytokines and chemokines, and significantly contribute to inflammation and remodeling. The eosinophils are a biomarker or a surrogate for the eosinophils that are in the sputum. However, sputum is not readily available, so that’s why we look at the eosinophil count. As mentioned, our office specializes in the treatment of severe eosinophilic asthma. There’s a great need for these type of medications – the monoclonal antibodies – because so many patients are still on daily prednisone or frequent bursts of prednisone, which have all the side effects.

What factors should be considered when deciding which drug to prescribe for severe eosinophilic asthma? (1:29)

There is almost an embarrassment of riches. We have six monoclonal antibodies: omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, and now finally tezepelumab. I strongly feel the government needs to develop a study to compare each monoclonal antibody because they don’t always account for cofactors such as the age, eosinophilic count, and the severity of the asthma. Retrospective studies have their falls, and so far there has been no prospective study of all six of them, so they’re hard to compare. We can make suggestions such as: omalizumab is good for chronic urticaria. So if you have chronic urticaria with your asthma, that might be a good drug to try. There’s also dupilumab, which has been shown to be effective for eczema and eosinophilic esophagitis, so that might be something to consider. Reslizumab sometimes based on the weight, but it has to be given intravenously, so that’s a problem. Dupilumab in one study has been shown to be efficacious for nasal polyposis, but then it gets complicated because there are some studies that show that for asthma, mepolizumab is better than tezepelumab, so it’s rather complicated.

Subtitles and transcript are autogenerated