Asthma and allergic diseases aren't one-size-fits-all. They're driven by intricate immune pathways, with type 2 (T2) inflammation playing a starring role - but far from the only one. Recent advances in immunology have opened the door to exciting new systemic treatments that go beyond traditional options, offering novel targets, longer dosing intervals, and even combination approaches.
A recent JACI clinical commentary breaks these emerging therapies into 4 key categories:
T2 cytokine inhibitors - Building on established biologics, newer agents refine targeting of key players like IL-4, IL-5, and IL-13 for better control in T2-high patients.
Alarmin blockers - These upstream therapies (e.g., targeting TSLP or IL-33) aim to shut down inflammation earlier, potentially benefiting a wider range of patients, including some with mixed or non-T2 profiles.
Effector cell modulators - Focusing on cells like eosinophils and mast cells to disrupt the downstream effects of inflammation.
Unconventional, broad immune, and non-T2 pathways - These tackle harder-to-treat cases where T2 mechanisms aren't dominant, addressing a critical unmet need.
While many of these therapies show strong promise - especially for severe, T2-driven asthma - challenges persist.
Identifying reliable predictive biomarkers, ensuring long-term safety, and effectively treating non-T2 inflammation remain hurdles.
Identifying reliable predictive biomarkers, ensuring long-term safety, and effectively treating non-T2 inflammation remain hurdles.