[Targeted therapies in severe asthma: the discovery of new molecules]

Abstract

The pathophysiological mechanisms involved in the chronicity and phenotypic heterogeneity of asthma offer the prospect of new therapeutic opportunities. A better clinical and biological characterisation of selected patients has led to the development of targeted therapies. Studies are under way to demonstrate their efficacy and tolerance and also their impact on the natural history of the disease. This revue aims to examine the therapies, developed during the last ten years, that are based on the immunological mechanisms involved in the pathophysiology of asthma, essentially in its severe form. The rapid expansion of human monoclonal antibodies has allowed testing of various immunological pathways. Anti-IgE, anti- IL-5, and anti-IL-13 strategies seem the most promising. Antagonists to TNF-alpha and I'IL-4 have not succeeded in reducing the events related to severe asthma in a convincing manner. Molecules targeted against thymic stromal lymphopoietin (TSLP) and I'IL-9 are under development. These approaches are involved in the development of therapeutic programmes adapted to the patient's phenotype, that is to say a personalised approach to care.

Keywords: Asthma; Asthme; Phenotypes; Phénotypes; Targeted therapies; Thérapies ciblées.