Current treatment in T2-low asthma

Paul M. O’Byrne, MB, is a professor of medicine and dean and vice-president of the Faculty of Health Sciences at McMaster University.

What is the currently recommended treatment in patients with T2-low asthma?

Until very recently we had very little to offer patients with severe T2-low asthma. These are patients identified as being predominantly noneosinophilic and for whom the biologics that target cytokines involved in severe eosinophilic asthma have proven to be not very effective. Really, the only treatment approach that had been shown to have any benefit, albeit not a great deal of benefit, was to use macrolide antibiotics 3 times a week, which did reduce the severe exacerbation rate at least in one well-designed double-blind clinical trial.

More recently, however, in the past year or so, a biologic has been approved for use in a number of countries, which targets an upstream cytokine thymic stromal lymphopoietin (TSLP) and which has been shown to be effective in reducing exacerbation risk in severe T2-low asthma, although the magnitude of benefit is still not quite as good as in T2-high asthma.