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Targeted Therapy for Severe Asthma in Children and Adolescents: Current and Future Perspectives

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Abstract

Severe asthma in children remains a significant issue. It places a heavy burden on affected individuals and society as a whole in terms of high morbidity, mortality, consumption of healthcare resources, and side effects from high-dose corticosteroid therapy. New, targeted biologic therapies for asthma have emerged as effective add-on options, complementing our expanding understanding of asthma phenotypes/endotypes and the underlying immunopathology of the disease spectrum. They include omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab. Omalizumab represents the first available therapeutic option for allergic asthma in patients as young as 6 years of age. Its efficacy and safety have been established by several randomized controlled trials specifically conducted in pediatric patients, leading to its final registration > 10 years ago. Three new interleukin (IL)-5 targeted agents, mepolizumab, reslizumab, and benralizumab, have been approved for the treatment of severe eosinophilic asthma starting from 6 years of age, and varying by country. More recently, dupilumab, a targeted agent against the IL-4 receptor α-chain, was approved for patients ≥12 years of age in the United States after pivotal trials were completed. The late-stage clinical testing of these targeted agents has mostly involved patients aged 12 years and up, and the application of those data to younger children can be inappropriate and carry risk. The efficacy and safety of these newer biologics in children should be supported by adequate research within this targeted age group. In this review, we will present the most recent evidence on these five biological therapies for severe asthma and will discuss dosage and administration, their efficacy, safety, and future prospects, with a focus on the pediatric age group, defined as age < 18 years.

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  1. Amelia Licari and Sara Manti are equally contributing co-first authors.

Authors and Affiliations

  1. Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, viale Golgi 19, 27100, Pavia, Italy

    Amelia Licari, Riccardo Castagnoli & Gian Luigi Marseglia

  2. Unit of Pediatric Genetics and Immunology, Department of Pediatrics, University of Messina, Messina, Italy

    Sara Manti & Carmelo Salpietro

  3. Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy

    Sara Manti, Giuseppe Fabio Parisi & Salvatore Leonardi

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  1. Amelia Licari
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Amelia Licari, Sara Manti, Riccardo Castagnoli, Giuseppe Fabio Parisi, Carmelo Salpietro, Salvatore Leonardi, and Gian Luigi Marseglia have no conflicts of interest that are directly relevant to the content of this study.

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Licari, A., Manti, S., Castagnoli, R. et al. Targeted Therapy for Severe Asthma in Children and Adolescents: Current and Future Perspectives. Pediatr Drugs 21, 215–237 (2019). https://doi.org/10.1007/s40272-019-00345-7

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