Biologika in der Behandlung des Asthma bronchiale

Biologika sind eine therapeutische Option für Patienten mit schwerem Asthma. Adäquate Compliance, optimale Ausschöpfung konservativer therapeutischer Möglichkeiten, Behandlung von Komorbiditäten und Vermeidung von Triggerfaktoren sind Voraussetzung vor dem Beginn des Einsatzes von Biologika. Eine sorgfältige Phänotypisierung der Patienten ist erforderlich, da die bisher verfügbaren Substanzen nur bei bestimmten Patienten Wirkung zeigen.

Abstract

Biologicals are a therapeutic option for patients with severe asthma. Difficult asthma in patients with untreated comorbidities or persistent trigger factors is much more common than severe refractory asthma. Optimized medical treatment, adherence to medication, elimination of trigger factors and treatment of comorbidities are essential before escalating the therapy with a biological. A careful phenotyping of patient with severe asthma is necessary because all available biological are only effective in certain phenotypes of the disease. For patients with severe allergic asthma an antibody against IgE (Omalizumab) is available. For patients with severe asthma and eosinophilic inflammation the Interleukin (IL)-5 Antibodies Mepolizumab and Reslizumab have recently been approved. The most prominent effect of biological treatment is the reduction of acute exacerbations in these patients. Further antibodies against IL-5 receptor (Benralizumab) or against the IL-4 receptor alpha chain (Dupilumab) are in advanced clinical development.

Kernaussagen

• Biologika sind eine therapeutische Option für Patienten mit schwerem Asthma.

• „Schwieriges“ Asthma bei Patienten mit schweren Komorbiditäten oder mit einer geringen Therapietreue kommt deutlich häufiger vor als schweres Asthma.

• Eine adäquate Compliance, eine optimale Ausschöpfung aller konservativen therapeutischen Möglichkeiten, Erfassung und Behandlung von Komorbiditäten und Vermeidung von Triggerfaktoren sind Voraussetzungen vor dem Beginn einer Therapie mit Biologika.

• Eine sorgfältige Phänotypisierung der Patienten ist erforderlich, da die bisher verfügbaren Substanzen nur bei bestimmten Patienten eine Wirkung zeigen.

• Zugelassen für Patienten mit schwerem allergischem Asthma bronchiale ist ein Antikörper gegen Immunglobulin-E (Omalizumab).

• Zugelassen bei schwerem Asthma mit einer erhöhten Anzahl eosinophiler Granulozyten im Blut sind die Interleukin-5-Antikörper Mepolizumab und Reslizumab.

• Wesentlicher Effekt einer Therapie mit Biologika ist die Senkung der Exazerbationsrate.

• Weitere Antikörper gegen den IL-5-Rezeptor (Benralizumab) oder gegen die IL-4-Rezeptor-Alpha-Kette (Dupilumab) sind in der fortgeschrittenen klinischen Entwicklung.

Schlüsselwörter

Asthma - Behandlung - Biologika - T2-Antwort - Interleukin

Key words

asthma - treatment - biologicals - T2 response - interleukin

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