What's in the Pipeline for Asthma Management

After reviewing the treatment options for asthma currently under development and in the clinical trial stage, researchers believe new therapeutic options, including tiotropium, will emerge to help doctors and patients improve the management of asthma. The review, conducted by Andrew McIvor, MD, of McMaster University, Firestone Institute for Respiratory Health in Hamilton, Ontario, Canada, was published in the Annals of Allergy, Asthma & Immunology on October 4, 2016.

Even when patients with asthma are treated according to current guidelines and best practices, some remain symptomatic. The author says, “There is an ongoing need for improvements in the management and control of asthma,” and that the present review, “examines recently published clinical data on emerging therapeutic options” for those patients.

After reviewing the available information regarding therapies in phase 2 and/or 3, the author identified interleukin agents such as benralizumab, reslizumab, dupilumab, brodalumab, lebrikizumab, and mepolizumab; a chemoattractant receptor-homologous molecule expressed on a T-helper type 2 lymphocyte antagonist called OC00459; roflumilast which is a phosphodiesterase-4 inhibitor; and the long-acting muscarinic antagonists glycopyrronium bromide, umeclidinium bromide, and tiotropium bromide.

“The tiotropium clinical trial program is currently the most advanced, with published data from different phase 2 and 3 randomized clinical trials in patients with asthma,” says the author, adding that current data shows the therapy to be an efficacious add-on therapy. It has compared well to placebo for both safety and tolerability. The reviewer adds, “In adult patients with severe asthma and a history of exacerbations, tiotropium has recently been recommended as an alternative therapeutic option.”

However, the author notes, “It should be considered that clinical trial efficacy is distinct from real-life effectiveness.” Additionally, cost-effectiveness must be taken into account, and the reviewer suggests that additional cost-effectiveness analyses will need to be performed to determine whether or not tiotropium as an add-on therapy is an affordable treatment option.

The author concludes saying that although tiotropium is further along the regulatory path, the other treatment options being studied show promise as well. He ends with, “The results of ongoing and future randomized clinical trials of these and other agents will help to address the current unmet need in patients with symptomatic asthma and to determine where these emerging therapeutic options will fit in future asthma treatment guidelines.”

Related Coverage:

Defining Treatment Options for Obese Asthmatic Patients

Add-On Tiotropium Therapy Improves Asthma Regardless of Many Patient Characteristics

Substantial Price Reduction Required for Asthma Treatment Mepolizumab to Meet Willingness-to-Pay Thresholds