Mario Castro, MD, prepared useful practice aids pertaining to asthma management for this CME activity titled "An Expert Analysis of New Data for Uncontrolled Persistent Asthma Treatments: Clinical Updates From Paris." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2yphUo5. CME credit will be available until October 28, 2019.

1. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Mechanistic Overview of Approved
and Emerging Therapies for the
Treatment of Asthma1
APC: antigen-presenting cell; FeNO: fraction of exhaled nitric oxide; IL: interleukin; ILC: innate lymphoid cell; iNOS: Inducible nitric oxide synthase; Th2: T helper cell type 2; TSLP: thymic stromal lymphopoietin.
1. Parulekar A et al. Curr Opin Pulm Med. 2017;23:3-11.
PRACTICE AID
APCIL-25
IL-33
TSLP
Anti–IL-25
Anti–IL-33
Tezepelumab
Benralizumab
Mepolizumab
Resilizumab
DP2
Receptor/
CRTH2 Antagonists
Fevipiprant
Dupilumab
Omalizumab
Th2
Th2
ILC2
B cell
IL-5
IL-4
IL-13
Periostin
Epithelial Injury Airway LumenAirway Epithelium
Allergen Allergen
Subepithelial Mucosa
FeNO
Prostaglandin
D2
Bone Marrow
Maturation
Bloodstream
Periostin
Eosinophils
Eosinophils
Activated
B cell
IgE
IL-13
Mast
Cell
iNOS
Eosinophil
Lebrikizumab
Tralokinumab
Access the activity, “An Expert Analysis of New Data for Uncontrolled Persistent Asthma Treatments:
Clinical Updates From Paris,” at www.peerview.com/GGG40.

2. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Selected Additional Updates on
Approved and Emerging Therapies
for the Treatment of Asthma
ACQ: Asthma Control Questionnaire; AQLQ(S): Standardized Asthma Quality of Life Questionnaire; CRS: chronic rhinosinusitis; DP2: prostaglandin receptor 2; FeNO: fractional exhaled nitric oxide; GAL-3: galectin-3; NP: nasal polyposis; Q2W: every 2 weeks;
SNOT-22: Sino-Nasal Outcome Test; TARC: thymus and activation-regulated chemokine.
1. Riccio AM et al. European Respiratory Society Congress 2018 (ERS 2018). Poster PA604. 2. Busse WW et al. ERS 2018. Abstract OA3567. 3. Corren J et al. ERS 2018. Poster PA1124. 4. Busse WW et al. ERS 2018. Poster PA1125. 5. Pavord ID et al. ERS 2018. Abstract
OA1651. 6. Wenzel SE et al. ERS 2018. Poster PA5005. 7. Rabe KF et al. ERS 2018. Poster PA5003. 8. Chen W et al. ERS 2018. Poster PA4401. 9. Busse WW et al. ERS 2018. Poster PA602.
PRACTICE AID
Access the activity, “An Expert Analysis of New Data for Uncontrolled Persistent Asthma Treatments:
Clinical Updates From Paris,” at www.peerview.com/GGG40.
Agent Trial/Analysis Results
Omalizumab
• Analysis of the PROXIMA study showed statistically significant differences in baseline plasma GAL-3 levels between responders and nonresponders
to omalizumab, specifically functional responders (who had 100-mL improvement in FEV1
after treatment for 1 year), indicating GAL-3 may be a
predictive biomarker to stratify responders1
Benralizumab
• Analysis of BORA, an extension from the SIROCCO/CALIMA trials, showed that 74% of patients with blood eosinophil ≥300 cells/mcL who received
benralizumab every 8 weeks from SIROCCO/CALIMA into BORA were exacerbation-free in year 2 of treatment2
• Improvements in lung function and asthma control were also maintained2
Dupilumab
• Results from LIBERTY ASTHMA QUEST showed dupilumab 200 or 300 mg significantly reduced the annualized rate of severe exacerbations during
the 52-week treatment period and improved FEV1
from baseline to week 523
• Analysis of LIBERTY ASTHMA QUEST also showed dupilumab improved ACQ-5, AQLQ(S), and SNOT-22 scores in asthma patients with and without
comorbid chronic CRS/NP3,4
• Dupilumab also reduced asthma exacerbations in patients with and without CRS/NP in LIBERTY ASTHMA QUEST5
• Data from LIBERTY ASTHMA QUEST also showed dupilumab at 200 or 300 mg Q2W produced a rapid and sustained suppression of FeNO and of type
2 inflammatory biomarkers (IgE, eotaxin-3, periostin, TARC)6
• Results of LIBERTY ASTHMA VENTURE, a 24-week study, showed that dupilumab 300 mg Q2W produced significant reduction of FeNO in the
airway as well as reduced expression in the plasma of eotaxin-3, in the serum of periostin, and of TARC in the serum at the onset of the trial and was
sustained over 24 weeks7
Fevipiprant
• A study by Chen et al showed that fevipiprant inhibited8
– DP2-mediated ILC2 migration
– Effect of prostaglandin D2 on the ILC2 cells
– Cellular aggregation
– Prostaglandin D2–mediated effects
– Production of type 2 cytokines from the ILC2 cells
Tralokinumab
• Data from the TROPOS study, which evaluated the oral steroid–sparing effect of tralokinumab, showed that at week 40 the percent reduction in the
oral steroid dose was not statistically significant for patients receiving tralokinumab vs placebo9

3. REVIEWRESPO
NSE
ASSESS
ADJUST TREATME
NT
• Symptoms
• Exacerbations
• Side effects
• Patient satisfaction
• Lung function
STEP 1
Consider
low-doseICS
PREFERRED
CONTROLLER
CHOICE
Other
controller
options
RELIEVER
STEP 2
STEP 3
STEP 4
STEP 5
Low-dose ICS
Low-dose
ICS/LABAb
Med/high-dose
ICS/LABA
Refer for
add-on
treatment
(eg,
tiotropium,a,d
anti-IgE,
anti–IL-5a
)
LTRA
Low-dose theophyllinea
Med/high-doseICS
Low-dose
ICS + LTRA
(or + theopha
)
As-needed SABA
As-needed SABA or
low-dose ICS/formoterolc
Add tiotropiuma,d
Med/high-dose
ICS + LTRA
(or + theopha
)
Add low-dose
OCS
• Diagnosis
• Symptom control and risk factors
(including lung function)
• Inhaler technique and adherence
• Patient preference
• Asthma medications
• Nonpharmacological strategies
• Treat modifiable risk factors
Access the activity, “An Expert Analysis of New Data for Uncontrolled Persistent
Asthma Treatments: Clinical Updates From Paris,” at www.peerview.com/GGG40.
GINA Guidelines:
Stepwise Approach to Control
Symptoms and Minimize Future Risk1
PRACTICE AID
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
a
Not for children 12 years.
b
For children 6-11 years, the preferred Step 3 treatment is medium-dose ICS.
c
For patients prescribed low-dose budesonide/formoterol or low-dose beclometasone/formoterol maintenance and reliever therapy.
d
Tiotropium by mist inhaler is an add-on treatment for patients ≥12 years with a history of exacerbations.
GINA: Global Initiative for Asthma; ICS: inhaled corticosteroid; IL: interleukin; LABA: long-acting beta-agonist; LTRA: leukotriene receptor antagonists; OCS: oral corticosteroid;
SABA: short-acting beta-agonist; theoph: theophylline.
1. https://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention. Accessed October 16, 2018.