Prospective direct comparison of biologic treatments for severe eosinophilic asthma: Findings from the PRISM study

Real-World Effectiveness and Safety of Mepolizumab in Severe Eosinophilic Asthma: Insights From the Korean Severe Asthma Registry (KoSAR)

Mepolizumab, an interleukin-5 antagonist, is globally recognized for its efficacy in randomized controlled trials for the treatment of severe eosinophilic asthma. The present study explored its real-world effectiveness and safety in a Korean cohort, filling a critical gap in current research. This multi-center retrospective study used data from the Korean Severe Asthma Registry, involving 67 patients treated with mepolizumab for uncontrolled severe asthma between September 2017 and July 2022. We assessed the effects of treatment on acute exacerbations, oral corticosteroid (OCS) maintenance dose, lung function, and quality of life. The notable findings included a marked reduction in the proportion of patients experiencing acute exacerbations, with 73.0% of patients reporting no exacerbations during the 6-month treatment period. At baseline, 31.8% of patients had reported no exacerbations over the prior 12 months. The OCS maintenance doses also decreased substantially, with only 3.2% of patients requiring OCS after 6 months. Additionally, there was an improvement in lung function. No severe adverse reactions were reported in this study, highlighting the safety of mepolizumab. This study confirmed that mepolizumab reduced exacerbations and OCS use, with additional improvements seen in asthma control, lung function, and patient-reported quality of life. These real-world findings support broader applications and reinforce the need for further research to optimize treatment strategies. Despite certain limitations, such as the small sample size and retrospective design, this study significantly contributes to the understanding of the real-world efficacy and safety of mepolizumab.

Therapeutic monoclonal antibodies in allergy: Targeting IgE, cytokine, and alarmin pathways

The etiology of allergy is closely linked to type 2 inflammatory responses ultimately leading to the production of allergen-specific immunoglobulin E (IgE), a key driver of many allergic conditions. At a high level, initial allergen exposure disrupts epithelial integrity, triggering local inflammation via alarmins including IL-25, IL-33, and TSLP, which activate type 2 innate lymphoid cells as well as other immune cells to secrete type 2 cytokines IL-4, IL-5 and IL-13, promoting Th2 cell development and eosinophil recruitment. Th2 cell dependent B cell activation promotes the production of allergen-specific IgE, which stably binds to basophils and mast cells. Rapid degranulation of these cells upon allergen re-exposure leads to allergic symptoms. Recent advances in our understanding of the molecular and cellular mechanisms underlying allergic pathophysiology have significantly shaped the development of therapeutic intervention strategies. In this review, we highlight key therapeutic targets within the allergic cascade with a particular focus on past, current and future treatment approaches using monoclonal antibodies. Specific targeting of alarmins, type 2 cytokines and IgE has shown varying degrees of clinical benefit in different allergic indications including asthma, chronic spontaneous urticaria, atopic dermatitis, chronic rhinosinusitis with nasal polyps, food allergies and eosinophilic esophagitis. While multiple therapeutic antibodies have been approved for clinical use, scientists are still working on ways to improve on current treatment approaches. Here, we provide context to understand therapeutic targeting strategies and their limitations, discussing both knowledge gaps and promising future directions to enhancing clinical efficacy in allergic disease management.