Uncontrolled asthma: anti-interleukin-13 antibodies may improve management

  • Li H & al.
  • PLoS ONE
  • 1 Jan 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • In patients with uncontrolled asthma despite inhaled corticosteroid (ICS) or ICS plus long-acting beta-agonist (LABA), anti-interleukin (IL)-13 monoclonal antibodies (lebrikizumab and tralokinumab) reduce exacerbations and improve pulmonary function and exacerbation rate.
  • Patients with high periostin levels had a lower risk for exacerbations with anti-IL-13 antibodies, but not those with low levels.

Why this matters

  • Findings suggest anti-IL-13 monoclonal antibodies could improve the management of uncontrolled asthma.
  • Periostin levels can identify patients likely to benefit from anti-IL-13 antibodies.

Study design

  • Meta-analysis of 5 randomised controlled trials including 3476 patients with poorly controlled asthma despite ICS or ICS+LABA who received anti-IL-13 antibodies, lebrikizumab and tralokinumab.
  • Primary outcomes: asthma exacerbation rate, forced expiratory volume in 1 second (FEV1), Asthma Quality of Life Questionnaire (AQLQ) scores, rescue medication use and adverse events.
  • Funding: Guangdong Province Natural Science Foundation; High-Level University Construction Project of Guangzhou University of Chinese Medicine and Traditional Chinese Medicine Bureau of Guangdong Province.

Key results

  • Significant reduction for risk in asthma exacerbation when participants were treated with lebrikizumab or tralokinumab vs placebo (mean difference [MD], −0.19; P<.001>
  • Patients with high periostin level (>50 ng/mL) had a lower risk for asthma exacerbation after receiving anti-IL-13 treatment (MD, −0.30; P<.001 but not those with low periostin levels.>
  • Anti-IL-13 treatment significantly improved patients’ FEV vs placebo (MD, 0.09; P<.001>
  • IL-13 treatment was associated with greater improvement in AQLQ scores (MD, 0.16; P<.00001>
  • Use of rescue medication was significantly lower with anti-IL-13 vs placebo (MD, −0.27; P=.01).
  • No significant difference in adverse events (pooled risk ratio, 1.00; 95% CI, 0.96–1.04).
  • Limitation

    • Heterogeneity between studies.