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Biologika beim schweren Asthma

Welcher Antikörper für wen?

Biologicals in severe asthma

Which antibody is for who?

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Das Asthma bronchiale ist eine heterogene Erkrankung mit einer komplexen molekularen und zellulären Pathophysiologie. Gezielte Eingriffe mit monoklonalen Antikörpern (Biologika) in diese Kaskade aus zahlreichen Zellen, Mediatoren und Zytokinen haben die Behandlung des schweren Asthmas deutlich verbessert. Aktuell stehen Antikörper zur Verfügung, die gegen Immunglobulin E (IgE) und gegen Interleukin-5 (IL-5) gerichtet sind. IgE ist ein zentrales Molekül in der Genese des allergischen Asthmas, es gibt jedoch eine zunehmende Evidenz, dass auch Patienten mit nichtallergischem Asthma von einer Anti-IgE-Therapie profitieren können. IL-5 ist essenziell für die eosinophile Inflammation beim Asthma und eine Anti-IL-5-Therapie ist wirksam bei Patienten mit einem refraktären eosinophilen Asthma bronchiale. Weitere Biologika werden gegenwärtig in klinischen Studien getestet. Nach den aktuellen Therapieempfehlungen und klinischen Standards werden Biologika (aktuell Anti-IgE oder Anti-IL-5) in der Dauertherapie des schweren Asthmas vor einer eventuellen Therapie mit systemischen Glukokortikosteroiden eingesetzt. Der Artikel gibt eine Übersicht über den aktuellen Stand der individualisierten Therapie des schweren Asthmas mit Biologika.

Abstract

Bronchial asthma is a heterogeneous disease with a complex molecular and cellular pathophysiology. Targeted interventions with monoclonal antibodies (biologicals) into this cascade of cells, mediators and cytokines resulted in marked improvement of the therapy of severe asthma. Currently, antibodies against immunoglobulin E (IgE) and against interleukin 5 (IL5) are clinically available. IgE is of paramount importance in the pathogenesis of allergic asthma; however there is increasing evidence that patients with nonallergic asthma also benefit from anti-IgE treatment. IL5 plays a crucial role in eosinophilic inflammation in asthma and anti-IL5 treatment is effective in patients with refractory eosinophilic asthma. Other biologicals are currently being investigated in clinical trials. According to current guidelines and clinical standards, biologicals (currently anti-IgE or anti-IL5) represent the preferred treatment option in patients with severe asthma, which should be evaluated before considering the use of systemic steroids. This article summarizes current concepts of individualized therapy of severe asthma with biologicals.

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Authors and Affiliations

  1. Universitätsklinik für Pneumologie, Universitätsklinikum der Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    J. Schreiber

  2. Schwerpunkt Pneumologie, III. Medizinische Klinik, Universitätsmedizin Mainz, Mainz, Deutschland

    S. Korn

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  1. J. Schreiber
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Correspondence to J. Schreiber.

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Interessenkonflikt

J. Schreiber und S. Korn geben Honorare für Vortrags- und Beratertätigkeiten von Novartis, Teva, AstraZeneca und GSK an.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

M. Lommatzsch, Rostock

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Schreiber, J., Korn, S. Biologika beim schweren Asthma. Pneumologe 14, 296–302 (2017). https://doi.org/10.1007/s10405-017-0109-y

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  • DOI: https://doi.org/10.1007/s10405-017-0109-y

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