Asthma: monoclonal antibodies

Monoclonal antibody therapy may considered in patients with asthma that does not respond to standard inhaler therapy. The table below shows some of the monoclonal antibodies that may be used:

Target _ Pathophysiological role in asthma _ Drug examples _ Indication | IgE_IgE binds allergens → activates mast cells & basophils → histamine, leukotrienes, cytokines → bronchoconstriction & airway inflammation _Omalizumab _ Severe allergic asthma with raised IgE & perennial allergen sensitisation | IL-5_ IL-5 is key for eosinophil growth, activation & survival → drives airway eosinophilia & tissue damage _ Mepolizumab Reslizumab _ Severe eosinophilic asthma | IL-5Rα_IL-5 receptor α expressed on eosinophils & basophils → targeting it depletes eosinophils via antibody-dependent cell cytotoxicity _ Benralizumab_ Severe eosinophilic asthma | IL-4Rα_ IL-4 and IL-13 drive type 2 inflammation → ↑ IgE synthesis, ↑ mucus production, airway hyperresponsiveness _ Dupilumab _ Severe eosinophilic / type 2 asthma or oral steroid–dependent asthma | TSLP _ TSLP is an epithelial “alarmin” cytokine released in response to triggers → activates multiple downstream pathways (Th2, IgE, eosinophils, mast cells) _ Tezepelumab_ Severe asthma, broad phenotype (not limited to eosinophilic/allergic) |