Asthma: What is expected of future treatments?

Since a few years, several targetted therapies are emerging in the field of severe asthma. They will partly respond to the unmet needs in asthma: an alternative to oral steroids, and the poor asthma control despite high levels of inhaled therapies. The available medications (anti-IgE) or the medications in development (anti-IL-5, anti-IL-13, anti-IL-4 or-IL5 receptors) are mainly targetting the Th2 inflammation in which eosinophils are predominant and which are responsive to oral steroids. The so called non-Th2 asthma in which neutrophils are sometimes predominant appears as orphan in this dynamic despite the development of anti-IL-17 antibodies. Thus, research efforts must be continued in severe asthma, to discover new therapeutic targets but also to discover biomarkers predictive of the response to targetted therapies. Only the discovery of such companion tests will allow the market access to these therapies. New techniques of nucleic acid sequencing could permit the acceleration of these discoveries in the dynamic of the personnalized medicine approach. (C) 2015 Published by Elsevier Masson SAS.