Tackling ‘People Remodelling’ in Corticosteroid-dependent Asthma with Type-2 Targeting Biologics and a Formal Corticosteroid Weaning Protocol

Abstract

People with severe corticosteroid-dependent asthma have greater morbidity, mortality and corticosteroid side effects than any other people with asthma. Just as type-2 inflammation and recurrent asthma attacks remodel airways, we propose the concept of ‘people remodelling’ to represent the utter disruption of people’s lives by the consequences of severe asthma and its associated corticosteroid treatments. To tackle this important problem, three biologics targeting type-2 inflammation – mepolizumab, benralizumab and dupilumab – have shown efficacy in tapering corticosteroids in dedicated phase III trials. We herein review the literature and propose an evidence-based, dose- and agent-specific corticosteroid weaning protocol for busy clinicians looking to achieve the best outcomes possible for their patients: independence from corticosteroids and reversal of people remodelling.