Potential strategic positioning of ADIs in allergic asthma versus alternative approaches
| Intervention | Examples | Remarks |
|---|---|---|
| Allergen delivery inhibitors | Group 1 HDM protease allergen inhibitors | Small molecule |
| Inhaled delivery to target organ | ||
| Attractive profile (nonhuman target, extracellular action) with disease modification | ||
| Root cause–directed | ||
| Potential to prevent exacerbations | ||
| Mechanistic differentiation | ||
| Potential addition to standard of care at all levels of disease severity | ||
| Potentially prescribable at nonspecialist level | ||
| Low cost of goods compared with biologics | ||
| Exploitable as combination therapy and/or other conditions | ||
| Alternative small molecules in discovery/development | Downstream signal transduction and effector mechanisms—various targets | Uncertain potential to surpass or add significantly to inhaled steroids |
| Multiple redundant effector pathways are confounders of efficacy | ||
| Potentially prescribable at nonspecialist level | ||
| Low cost of goods compared with biologics | ||
| Biologics—approved or in development | Anticytokine mAbs | High cost of goods |
| Antireceptor mAbs | Mainly applicable to severe disease only | |
| Anti-IgE mAbs | Inconvenient to use | |
| Anti-IgE vaccine (pAb) | Multiple redundant pathways are confounders of efficacy | |
| High safety barriers (esp. IgE vaccine) | ||
| Specialist use only | ||
| Patchy targeting of innate pathways | ||
| Immunotherapy | Allergen-specific immunotherapy Immune deviation | Moderately high cost of goods |
| Can be inconvenient to use | ||
| Specialists must be involved in GP use | ||
| Chronic safety of immune deviation is unproven | ||
| Poor targeting of key innate pathways |
GP, general practitioner; mAb, monoclonal antibody; pAb, polyclonal antibody.