Printed From:

IN YOUR PATIENTS WITH ASTHMA

LOOK BEYOND EOSINOPHIL AND IgE LEVELS TO GET A CLEARER PICTURE OF TYPE 2 INFLAMMATION

TYPE 2 INFLAMMATION OCCURS
IN ~50%a TO 70%b
OF ADULT PATIENTS WITH ASTHMA1,2

a N=205.

b N=52.

Asthma phenotypes associated with type 2 inflammatory biomarkers

Adapted from Ray et al, 2015.

c Muraro A et al, 2016.
d Brusselle GG et al, 2013.

References: 1. Seys SF, Scheers H, den Brande PV, et al. Cluster analysis of sputum cytokine-high profiles reveals diversity in T(h)2-high asthma patients. Respir Res. 2017;18(39):1-10. 2. Peters MC, Mekonnen ZK, Yuan S, et al. Measure of gene expression in sputum cells can identify TH2-high and TH2-low subtypes of asthma. J Allergy Clin Immunol. 2014;133(2):388-394. 3. Fahy J. Type 2 inflammation in asthma—present in most, absent in many. Nat Rev Immunol. 2015;15(1):57-65. 4. Gauthier M, Anuradha R, Wenzel S. Evolving concepts of asthma. Am J Respir Crit Care Med. 2015;192(6):660-668. 5. Parulekar A, Diamant Z, Hanania NA. Role of T2 inflammation biomarkers in severe asthma. Curr Opin Pulm Med. 2016;22(1):59-68. 6. Ray A, Raundhal M, Oriss TB, Ray B, Wenzel SE. Current concepts of severe asthma. J Clin Invest. 2016;126(7):2394-2403. 7. Wenzel SE. Emergence of biomolecular pathways to define novel asthma phenotypes: type-2 immunity and beyond. Am J Respir Cell Mol Biol. 2016;55(1):1-4. 8. Ray A, Oriss TB, Wenzel SE. Emerging molecular phenotypes of asthma. Am J Physiol Lung Cell Mol Physiol. 2015;308(2):L130-L140. 9. Muraro A, Lemanske RF, Hellings PW, et al. Precision medicine in patients with allergic diseases: Airway diseases and atopic dermatitis—PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2016;137(5):1347-1358. 10. Brusselle GG, Maes T, Bracke KR. Eosinophilic airway inflammation in nonallergic asthma. Nat Med. 2013;19(8):977-999.

IN UNCONTROLLED PERSISTENT ASTHMA
IL-4, IL-5, AND IL-13 ARE
KEY DRIVERS OF
TYPE 2 INFLAMMATION1-3

IL-5 promotes activation,
survival, and recruitment of
eosinophils5-8

IL-13 causes an overexpression of goblet cell hyperplasia and drives increased mucus secretion9

Key cytokines driving type 2 inflammation

Adapted from Hammad H et al, 2008.

Production of downstream
cytokines, including
IL-5, IL-9, and IL-134

Th2 cell differentiation, mast cell recruitment, and class switching in B cells to produce IgE4

Recruitment of eosinophils5-8

References: 1. Fulkerson PC, Rothenberg ME. Targeting eosinophils in allergy, inflammation and beyond. Nat Rev Drug Discov. 2013;12(2):1-23. 2. Caruso M, Crisafulli E, Lizzio R, Polosa R. Biologic therapy for atopic asthma and beyond. Curr Opin Allergy Clin Immunol. 2013;13(6):677-685. 3. Hammad H, Lambrecht BN. Dendritic cells and epithelial cells: linking innate and adaptive immunity in asthma. Nat Rev Immunol. 2008;8(3):193-204. 4. Maes T, Joos GF, Brusselle GG. Targeting interleukin-4 in asthma: lost in translation? Am J Respir Cell Mol Biol. 2012;47(3):261-270. 5. Berair R, Pavord ID. Rationale and clinical results if inhibiting interleukin-5 for the treatment of severe asthma. Curr Allergy Asthma Rep. 2013;13(5):469-476. 6. Fahy J. Type 2 inflammation in asthma—present in most, absent in many. Nat Rev Immunol. 2015;15(1):57-65. 7. Brusselle GG, Maes T, Bracke KR. Eosinophilic airway inflammation in nonallergic asthma. Nat Med. 2013;19(8):977-979. 8. Toru H, Pawankar R, Ra C, Yata J, Nakahata T. Human mast cells produce IL-13 by high-affinity IgE receptor cross-linking: enhancing IL-13 production by IL-4-primed human mast cells. J Allergy Clin Immunol. 1998;102(3):491-502. 9. Zhu Z, Homer RJ, Wang Z, et al. Pulmonary expression of interleukin-13 causes inflammation, mucus hypersecretion, subepithelial fibrosis, physiologic abnormalities and eotaxin production. J Clin Invest. 1999;103(6):779-778.

LOOK BEYOND EOSINOPHIL AND
IgE LEVELS TO BETTER UNDERSTAND
TYPE 2 ASTHMA

IgEEOS

~71% of severe asthma patientsa not treated with
an anti-IgE biologic were not eligible for currently
available biologics, highlighting the unmet medical need1

a N=502; Australia, USA, Canada (65%); France, Germany, UK (76%).

blue cloud icon

Periostin

Elevated periostin levels are often associated with Type 2 inflammation2

yellow cloud icon

FeNO

Elevated FeNO levels are often associated with Type 2 inflammation2

b Exacerbations were 3 times more likely to occur in patients with uncontrolled asthma than in those with better asthma control3

  • Patients miss out on outdoor, physical, and other daily activities4
  • Anxiety and depression worsen symptoms and complicate disease management5

Patients with a history of exacerbations had about twice the yearly decline in FEV1 over 3 years than those without exacerbations6

References: 1. Albers FC, Müllernová H, Gunsoy NB, et al. Biologic treatment for real-world patients with severe asthma: The IDEAL study. J Asthma. 2017; doi: 10.1080/02770903.2017.1322611. 2. Gauthier M, Anuradha R, Wenzel S. Evolving concepts of asthma. Am J Respir Crit Care Med. 2015;192(6):660-668. 3. Haselkorn T, Fish JE, Zeiger RS, et al. Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin. 2009;124(5):895-902. 4. Chen H, Blanc PD, Hayden ML, et al. Assessing productivity loss and activity impairment in severe or difficult-to-treat asthma. Value Health. 2008;11(2):231-239. 5. Di Marco F, Verga M, Santus P, et al. Close correlation between anxiety, depression, and asthma control. Respir Med. 2010;104(1):22-28. 6. O’Byrne PM, Pedersen S, Lamm CJ, et al. Severe exacerbations and decline in lung function in asthma. Am J Respir Crit Care Med. 2009;179(1):19-24. 7. Wenzel S. Severe asthma: from characteristics to phenotypes to endotypes. Clin Exp Allergy. 2012;42(5):650-658. 8. Agache I, Akdis C, Jutel M, Virchow JC. Untangling asthma phenotypes and endotypes. Allergy. 2012;67(7):835-846. 9. Bjermer L. Time for a paradigm shift in asthma treatment: From relieving bronchospasm to controlling systemic inflammation. J Allergy Clin Immunol. 2007;120(6):1269-1275. 10. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. 2015. 11. Diamant Z, Mantzouranis E, Bjermer L. Montelukast in the treatment of asthma and beyond. Expert Rev Clin Immunol. 2009;5(6)639-658.

Register now