Omalizumab as the first drug of genetically engineered biological therapy: New expectations and relevance of use in bronchial asthma

Recognition of the fact that asthma is a complex, multifactorial disorder has led to a more serious focus on the patient and on those disorders of his condition that contribute to the more or less general clinical severity of the disease. Recognition of the fact that asthma is a complex, multifactorial disorder has led to a more serious focus on the patient and on those disorders of his condition that contribute to the more or less general clinical severity of the disease. So, in the pathogenesis of bronchial asthma, T2 and non-T2 endotypes of asthma are determined. By definition, a disease endotype is a subtype of a disease determined by a unique or distinctive functional or pathophysiological mechanism. One endotype of astma may underlie several phenotypes, since the endotype is the molecular basis of phenotypes. The most common and obvious phenotype of bronchial asthma is allergic or atopic. The discovery of IgE also opened a new era in the understanding of the mechanisms of the formation of allergic diseases, including asthma. It is logical that the first targeted (targeted) drug for patients with severe allergic bronchial asthma was omalizumab (anti-IgE therapy). Clinical studies have demonstrated conclusively that in patients with asthma requiring high-dose inhaled corticosteroids and/or systemic glucocorticosteroids, anti-IgE therapy reduces exacerbation rates, reduces asthma severity, and allows withdrawal or significant lower doses of systemic drugs. Omalizumab reduces eosinophilic infiltration of the submucosal layer of the bronchi, eosinophilia in sputum, which correlates with a decrease in the fraction of exhaled nitric oxide. Omalizumab modifies the severe course of allergic asthma in children and adults, reduces the thickness of the bronchial wall, increases the lumen of the bronchi (special CT studies), which is clinically manifested by an increase in FEV1. The anti-inflammatory effect of omalizumab has also been proven.