Personalized approach to the biologicals’ selection in patients with severe asthma: real practice tools and new possibilities

Currently, the most effective approach to treating patients with severe uncontrolled asthma is the use of biologicals. These treatments are highly effective and safe, but not universal. Different biologicals block various parts of asthma pathogenesis. Also, biologicals have different effectiveness in relation to comorbidities. In this regard, the targeted therapy selection should be personalized, endotypeand phenotype-oriented. The aim of this review was to analyze the literature data on methods for personalized biologicals’ selection in patients with severe asthma that are currently used in clinical practice, as well as new prospects in this area. Conclusion. Laboratory and instrumental examination methods currently used for endoand phenotyping of severe asthma help in identifying the key pathogenetic factor in the disease development that serves as a basis for selection of the biological. However, biomarkers identified during routine examination are not absolute and are prone to exceptions. Also, the targeted therapy selection is based on a subjective determination of the prevailing pathogenetic mechanism when a patient with severe asthma has a mixed disease phenotype and meets the criteria for prescribing all available biologicals. Therefore, the search for biomarkers that predict the effect of a particular biological remains a relevant direction for future studies. The combined use of clinical, molecular-genetic examination results and evaluation of epigenetic markers can help in solving this problem. This review provides current data on the biologicals used in severe asthma treatment, the phenotyping and endotyping tools used in real practice, and also describes promising areas of the epigenetic biomarkers research.