Novel Asthma Therapies: A Review

Preeti      Chopra; Inderpal      Randhawa; Terry      Chin

Abstract

Objective: To describe novel medical therapies in asthma.

Data Sources: A comprehensive Pub Med search was performed and studies published between 2000 and 2008 were reviewed. Updated studies from 2009 to 2011 were also included. A focus was placed on randomized, controlled studies.

Results: Indacaterol, a once daily inhaled long acting beta 2-agonist (LABA) increased forced expiratory volume in 1 sec (FEV1) and resulted in prolonged bronchodilation. Ciclesonide, a pro-drug inhaled corticosteroid, has been shown to increase FEV1 as well as improve morning, evening, and site-measured peak expiratory flow (PEF) with fewer adverse effects. Fluticasone/formoterol (Flutiform©), a combination inhaled corticosteroid and LABA, showed a reduction in severe exacerbations requiring hospitalization, increased FEV1, less rescue medication use and higher quality of life scores. Extra-fine beclomethasone with formoterol also appears promising. Several immunomodulating drugs are on the horizon. Roflumilast, an oral once-daily PDE-4 inhibitor, improved forced vital capacity (FVC) and reduced the need for rescue medication. There are encouraging results with mepolizumab and reslizumab, anti-leukin-5 monoclonal antibody preparations, in a specific subset of asthmatic patients. Other approaches such as anti-interleukin-5 receptor blockage and anti-interleukin-9 monoclonal antibodies are in the early stages of development. On the other hand, treatment directed toward anti-tumor necrosis factor in asthmatics has been disappointing.

Conclusions: Novel therapies for asthma continue to evolve. Inhaled corticosteroids continue to be at the forefront of treatment. However, combination therapies, novel bronchodilators, and PDE4 inhibitors show promise. Many of these therapies still require further study particularly against the current standards in controller therapy.

Keywords: Anti-inflammatory medications, asthma, immunotherapy, inhaled bronchodilators, inhaled corticosteroids, monoclonal antibody

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