Safety of anti-IL-5 compounds for the treatment of eosinophilic asthma with a focus on special populations

INTRODUCTION: Asthma treatment has undergone a substantial change since monoclonal antibodies have been approved as treatment. IL-5 is a crucial player within the immunological pathways underlying asthma pathobiology. Selectively targeting IL-5 and its receptor demonstrated on long-term observations an optimal safety and efficacy profile in asthma patients. However, in some special populations, the evidence related to the safety data is still limited. AREAS COVERED: The present review summarizes the currently available literature on the overall safety of anti-IL-5 compounds, including a focus on partial vs complete blood eosinophil depletion in response to the different therapies. Furthermore, data on anti-IL-5 antibodies in children, pregnant patients and old people in terms of safety profile have been critically reviewed. EXPERT OPINION: Limited data are available in children, pregnant women and elderly. The last two categories are usually excluded by the clinical trials enrollment, and a few randomized studies are available for children. However, the real-world evidence, aligned with the highly selective mechanism of action, supports the implementation of the anti-IL-5 therapies in the three subgroups mentioned above. Of course, an individualized approach carefully evaluating the risk-benefit balance and a close monitoring are highly recommended in those patients.