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A utilização de medicamentos biológicos na terapêutica da asma
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Orientador(es)
Resumo(s)
A asma é uma doença inflamatória crónica que afeta cerca de 235 milhões de pessoas em todo o mundo. A maioria dos doentes asmáticos responde bem aos corticosteróides inalatórios e agonistas adrenérgicos β2, terapêutica atualmente disponível; no entanto, para muitos doentes, a doença continua a ser mal controlada. A maioria dos avanços, na terapêutica da asma, tem ocorrido através da melhoria destas classes de fármacos. Por outro lado, muitas das novas terapêuticas são específicas, destinadas a um único mediador ou recetor, e são improváveis de ter um efeito clínico marcado, embora possam ser eficazes em fenótipos específicos de asma. Terapêuticas-alvo incluem estratégias como a ativação das células dendríticas através dos recetores TLR- 9, a interrupção da ação das citocinas TH2 com bloqueadores de citocinas e anticorpos monoclonais, a promoção do desenvolvimento de respostas TH1, o bloqueio das vias mediadas pela IgE e o bloqueio do TNF-α. O omalizumab é a única terapêutica biológica, neste momento, aprovada na asma. Uma melhor compreensão da heterogeneidade da asma deve permitir para alvos específicos de diferentes fenótipos, da doença, terapêuticas específicas, incluindo imunomoduladores.
Embora a cura seja improvável de ser desenvolvida num futuro próximo, uma maior compreensão dos mecanismos da doença poderá trazê-la para uma realidade mais próxima.
Asthma is a chronic inflammatory disease that affects about 235 million people worldwide. Most asthmatic individuals respond well to the currently available treatments of inhaled corticosteroids and β-adrenergic agonists; however for many patients, their disease remains poorly controlled. Most advances in asthma therapy have occurred through improving these drug classes. On the other hand, many new treatments are specific, targeting a single mediator or receptor, and are unlikely to have a major clinical effect, although they might be effective in specific asthma phenotypes. Targeted therapies have included strategies to activate dendritic cells through the TLR-9 receptors, to interrupt the action of TH2 cytokines with cytokine blockers and monoclonal antibodies, to promote development of TH1 responses, to block IgE mediated pathways and to block TNF-α. Omalizumab is the only biological therapy that has an approved indication in asthma at this time. An improved understanding of the heterogeneity of asthma should allow for specific targeting of different disease phenotypes specific therapies including immunomodulators. Although a cure is unlikely to be developed in the near future, a greater understanding of disease mechanisms could bring such a situation nearer to reality.
Asthma is a chronic inflammatory disease that affects about 235 million people worldwide. Most asthmatic individuals respond well to the currently available treatments of inhaled corticosteroids and β-adrenergic agonists; however for many patients, their disease remains poorly controlled. Most advances in asthma therapy have occurred through improving these drug classes. On the other hand, many new treatments are specific, targeting a single mediator or receptor, and are unlikely to have a major clinical effect, although they might be effective in specific asthma phenotypes. Targeted therapies have included strategies to activate dendritic cells through the TLR-9 receptors, to interrupt the action of TH2 cytokines with cytokine blockers and monoclonal antibodies, to promote development of TH1 responses, to block IgE mediated pathways and to block TNF-α. Omalizumab is the only biological therapy that has an approved indication in asthma at this time. An improved understanding of the heterogeneity of asthma should allow for specific targeting of different disease phenotypes specific therapies including immunomodulators. Although a cure is unlikely to be developed in the near future, a greater understanding of disease mechanisms could bring such a situation nearer to reality.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2015
Palavras-chave
Inflamação das vias aéreas Células TH2 e TH1 Células dendríticas Bloqueadores de citocinas Anticorpos monoclonais IgE Omalizumab Mestrado Integrado - 2015