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Allergy. 2019 Mar;74(3):432-448. doi: 10.1111/all.13642. Epub 2019 Jan 8.

Comparing biologicals and small molecule drug therapies for chronic respiratory diseases: An EAACI Taskforce on Immunopharmacology position paper.

Author information

Comparative Medicine, The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria.
Molecular Cell Biology Group, National Heart & Lung Institute, Imperial College London, London, UK.
Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain.
Department of Respiratory Medicine and Allergology, Lung and Allergy Research, Allergy, Asthma and COPD Competence center, Lund University, Lund, Sweden.
Pulmonary Unit, Department of Biomedical Sciences, Dentistry, Morphological and Functional Imaging (BIOMORF), University of Messina, Messina, Italy.
Department of Medicine, Section of Pharmacology, University of Perugia, Perugia, Italy.
Experimental Studies Medicine at National Heart & Lung Institute, Imperial College London, Royal Brompton & Harefield NHS Trust, London, UK.
Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Respiratory Medicine and Allergology, Institute for Clinical Science, Skane University Hospital, Lund, Sweden.
Allergy Unit and Research Laboratory, Regional University Hospital of Málaga and Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain.
Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Immunology, University Hospital Zurich, Zurich, Switzerland.
Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Faculty of Science, Division of Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.


Chronic airway diseases such as asthma and chronic obstructive pulmonary disease (COPD), together with their comorbidities, bear a significant burden on public health. Increased appreciation of molecular networks underlying inflammatory airway disease needs to be translated into new therapies for distinct phenotypes not controlled by current treatment regimens. On the other hand, development of new safe and effective therapies for such respiratory diseases is an arduous and expensive process. Antibody-based (biological) therapies are successful in treating certain respiratory conditions not controlled by standard therapies such as severe allergic and refractory eosinophilic severe asthma, while in other inflammatory respiratory diseases, such as COPD, biologicals are having a more limited impact. Small molecule drug (SMD)-based therapies represent an active field in pharmaceutical research and development. SMDs expand biologicals' therapeutic targets by reaching the intracellular compartment by delivery as either an oral or topically based formulation, offering both convenience and lower costs. Aim of this review was to compare and contrast the distinct pharmacological properties and clinical applications of SMDs- and antibody-based treatment strategies, their limitations and challenges, in order to highlight how they should be integrated for their optimal utilization and to fill the critical gaps in current treatment for these chronic inflammatory respiratory diseases.


antibodies; asthma; biologicals; chronic obstructive pulmonary disease; small molecule drugs


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