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Pediatrics Terapia 2021, 3 ( 398 ) :  32  -  42

Biologic therapy of severe asthma in children

Summary: Asthma is one of the most common chronic diseases among children, and, owing to its heterogeneous nature, presents various symptoms and course. The Global Initiative for Asthma (GINA) provides annually updated guidelines for the diagnosis and treatment of asthma, which facilitate an objective assessment of both the severity of symptoms and the therapeutic response, and, subsequently, the adoption of appropriate therapy. Severe asthma is a form of asthma that requires treatment to Step 4 or 5 of the GINA guidelines or treatment with systemic corticosteroids > 50% of days in a year to maintain control over the disease, or a form of asthma that remains uncontrolled despite the intensive treatment described above. Establishing a diagnosis of severe asthma in a child requires identification of the disease phenotype and potential adoption of biologic therapy. The GINA guidelines identify the possibility of treating severe, uncontrolled asthma in children with omalizumab (anti-IgE antibody), mepolizumab (anti-IL-5 antibody), benralizumab (anti-IL-5 receptor α antibody) and dupilumab (anti-IL-4 receptor α antibody). Currently in Poland there is one drug program financed by the National Health Fund for children with severe, uncontrolled asthma ‒ the omalizumab treatment program. This treatment is designed for children older than six years with severe IgE-mediated asthma with confirmed year-round allergies. The other two drug programs available in Poland ‒ mepolizumab and benralizumab ‒ are targeted at the treatment of severe eosinophilic asthma in adult patients. The article discusses biopharmaceuticals adopted in the treatment of severe asthma in Poland, with particular regard to omalizumab. It presents the current criteria for enrolment in drug programs with omalizumab, mepolizumab and benralizumab, as well as the available biological therapy options worldwide.
Keywords: severe asthma, uncontrolled asthma, biologic therapy, omalizumab, mepolizumab, benralizumab

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