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Targeted Therapy for Older Patients with Uncontrolled Severe Asthma: Current and Future Prospects

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Abstract

Severe asthma in the elderly places a high burden on affected individuals and society. Emerging therapies target specific phenotypes of the asthma disease spectrum, and can be beneficial for older asthmatics, albeit their response might be altered due to age-related characteristics. Paradoxically, these characteristics are often ground for exclusion from clinical trials. The question thus arises how the senior asthmatic population can successfully enter the era of targeted therapy. Therefore, we highlight characteristics of this population relevant to effective treatment, and review the evidence for targeted therapy in elderly patients. For targeted therapy it is important to account for aging, as this affects the distribution of phenotypes (e.g. late-onset asthma, non-eosinophilic asthma) and may alter biomarkers and drug metabolism. Elderly asthmatics suffer from age-related comorbidities and subsequent polypharmacy. A systematic search into targeted asthma therapy yielded no randomized clinical trials dedicated to older asthmatics. Post hoc analyses of the anti-immunoglobulin E agent omalizumab indicate similar efficacy in both younger and older adults. Conference abstracts on anti-interleukin-5 and anti-interleukin-13 therapy suggest even more pronounced effects of targeted treatments in late-onset disease and in asthmatic patients 65 years or older, but full reports are lacking. For non-eosinophilic asthma in the elderly, there is not yet high-level evidence for targeted therapy, but macrolides may offer a viable option. In conclusion, there is a gap in knowledge regarding the effect of older age on the safety and efficacy of targeted asthma therapy. Further investigations in the elderly are needed, with special emphasis on both late-onset asthma and therapeutics for non-eosinophilic asthma.

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Acknowledgments

The systematic search strategy was set up with the support of Gerdien de Jonge, MSc, Biomedical Information Specialist.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    E. W. de Roos, L. Lahousse & G. G. O. Brusselle

  2. Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    E. W. de Roos, L. Lahousse & G. G. O. Brusselle

  3. Department of Respiratory Medicine, Franciscus Gasthuis, 3045 PM, Rotterdam, The Netherlands

    J. C. C. M. in ’t Veen & G.-J. Braunstahl

  4. Department of Respiratory Medicine, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands

    G.-J. Braunstahl & G. G. O. Brusselle

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  1. E. W. de Roos
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  3. G.-J. Braunstahl
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Correspondence to G. G. O. Brusselle.

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Conflict of interest

ER states that she has no financial conflict of interest. JV has, within the last 5 years, received honoraria for lectures from AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Teva; he is a member of advisory boards for Chiesi. G-JB has, within the last 5 years, received honoraria for lectures from AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Novartis, ALK-Abello, Mundipharma and Takeda; he is a member of advisory boards for Boehringer-Ingelheim, GlaxoSmithKline, ALK-Abello, Meda Pharma and Novartis. LL has performed consultancy for Boehringer-Ingelheim GmbH and received an AstraZeneca Scientific Award and travel support from Novartis, the European Respiratory Society, and the Belgian Respiratory Society. GB has, within the last 5 years, received honoraria for lectures from AstraZeneca, Boehringer-Ingelheim, Chiesi, GlaxoSmithKline, Merck Sharp & Dohme, Novartis, Pfizer, Teva and UCB; he is a member of advisory boards for AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, Regeneron and Sanofi.

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LL is a Postdoctoral Fellow of the Research Foundation-Flanders (FWO). No funding source was involved in the selection, review and interpretation of the data or approval of the manuscript.

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de Roos, E.W., in ’t Veen, J.C.C.M., Braunstahl, GJ. et al. Targeted Therapy for Older Patients with Uncontrolled Severe Asthma: Current and Future Prospects. Drugs Aging 33, 619–628 (2016). https://doi.org/10.1007/s40266-016-0397-7

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