Regions
MAIN/REGIONS
regions/
Regions
  1. Americas
  2. Asia & Oceania
  3. Europe
  4. Middle East & Africa
  1. Solutions
  2. Products
  3. Insights
  4. About
  5. Careers
  6. Contact Us
MAIN/search
MAIN/Solutions
Solutions/
SOLUTIONS
  • Research & Development
  • Real World Evidence
  • Commercialization
  • Safety & Regulatory Compliance
  • Technologies
LIFE SCIENCE SEGMENTS
HEALTHCARE SEGMENTS
THERAPEUTIC AREAS

Impacting People's Lives

"We strive to help improve outcomes and create a healthier, more sustainable world for people everywhere.

LEARN MORE
Harness the power to transform clinical development

Reimagine clinical development by intelligently connecting data, technology, and analytics to optimize your trials. The result? Faster decision making and reduced risk so you can deliver life-changing therapies faster.

Research & Development Overview
Research & Development Quick Links
Real World Evidence. Real Confidence. Real Results.

Generate and disseminate evidence that answers crucial clinical, regulatory and commercial questions, enabling you to drive smarter decisions and meet your stakeholder needs with confidence.

REAL WORLD EVIDENCE OVERVIEW
Real World Evidence Quick Links
See markets more clearly. Opportunities more often.

Elevate commercial models with precision and speed using AI-driven analytics and technology that illuminate hidden insights in data.

COMMERCIALIZATION OVERVIEW
Commercialization Quick Links
Service driven. Tech-enabled. Integrated compliance.

Orchestrate your success across the complete compliance lifecycle with best-in-class services and solutions for safety, regulatory, quality and medical information.

COMPLIANCE OVERVIEW
Safety & Regulatory Compliance Quick Links
Intelligence that transforms life sciences end-to-end.

When your destination is a healthier world, making intelligent connections between data, technology, and services is your roadmap.

TECHNOLOGIES OVERVIEW
Technology Quick Links
MAIN/Products
Products/
CLINICAL PRODUCTS
COMMERCIAL PRODUCTS
COMPLIANCE, SAFETY, REG PRODUCTS
REAL WORLD PRODUCTS

CASE STUDY

"Data in a Day

LEARN MORE
MAIN/Insights
Insights/
BLOGS, WHITE PAPERS & CASE STUDIES

Explore our library of insights, thought leadership, and the latest topics & trends in healthcare.

DISCOVER INSIGHTS
THE IQVIA INSTITUTE

An in-depth exploration of the global healthcare ecosystem with timely research, insightful analysis, and scientific expertise.

SEE LATEST REPORTS

INSTITUTE REPORT

"Digital Health Trends 2024 - Implications for Research and Patient Care

READ MORE

EMEA Insights

"IQVIA thought leadership with a focus on EMEA.

Learn more

WHITE PAPER

"DCTs Deliver Big ROI

LEARN MORE

WHITE PAPER

"Capturing value at scale: The $4 billion RWE imperative

LEARN MORE
MAIN/About
About/
FEATURED INNOVATIONS
  • IQVIA Connected Intelligence™
  • IQVIA Healthcare-grade AI™
  • IQVIA AI Assistant
  • Human Data Science Cloud
  • IQVIA Innovation Hub
  • Decentralized Trials
  • Patient Experience Solutions with Apple devices
WHO WE ARE
NEWS & RESOURCES

INVESTOR RELATIONS

"Visit our investor relations site for more information.

LEARN MORE
Unlock your potential to drive healthcare forward

By making intelligent connections between your needs, our capabilities, and the healthcare ecosystem, we can help you be more agile, accelerate results, and improve patient outcomes.

LEARN MORE
IQVIA AI is Healthcare-grade AI

Building on a rich history of developing AI for healthcare, IQVIA AI connects the right data, technology, and expertise to address the unique needs of healthcare. It's what we call Healthcare-grade AI.

LEARN MORE
Meet the IQVIA AI Assistant

Your new expert analyst is here. Be at the forefront of data-driven decision-making with a new generative AI tool that enables you to interact with our products and solutions like never before. Get results you can trust, faster.

LEARN MORE
Your healthcare data deserves more than just a cloud.

The IQVIA Human Data Science Cloud is our unique capability designed to enable healthcare-grade analytics, tools, and data management solutions to deliver fit-for-purpose global data at scale.

LEARN MORE
Innovations make an impact when bold ideas meet powerful partnerships

The IQVIA Innovation Hub connects start-ups with the extensive IQVIA network of assets, resources, clients, and partners. Together, we can help lead the future of healthcare with the extensive IQVIA network of assets, resources, clients, and partners.

LEARN MORE
Proven, faster DCT solutions

IQVIA Decentralized Trials deliver purpose-built clinical services and technologies that engage the right patients wherever they are. Our hybrid and fully virtual solutions have been used more than any others.

LEARN MORE
IQVIA Patient Experience Solutions with Apple devices

Empowering patients to personalize their healthcare and connecting them to caregivers has the potential to change the care delivery paradigm.

LEARN MORE
MAIN/Careers
Careers/
WORKING AT IQVIA

Our mission is to accelerate innovation for a healthier world. Together, we can solve customer challenges and improve patient lives.

LEARN MORE
LIFE AT IQVIA

Careers, culture and everything in between. Find out what’s going on right here, right now.

LEARN MORE

WE’RE HIRING

"Improving human health requires brave thinkers who are willing to explore new ideas and build on successes. Unleash your potential with us.

SEARCH JOBS
MAIN/Contact Us
Contact Us/
Blog
Advancing Standards of Care in Asthma
New guidelines and biologic therapies drive improvements
Feb 22, 2024
  • Blogs
  • Advancing Standards of Care in Asthma

The standard of care for asthma is seeing an evolution away from inhaled corticosteroids (ICS) and long-acting beta-agonist (LABA) combinations as maintenance therapy alone, to also include these as “as-needed” therapy, and away from albuterol as-needed therapy alone. This is occurring particularly in the US, UK and European Union.

Asthma affects around 262 million people worldwide, accounting for 461,000 deaths globally in 2019.1 Low- and middle-income countries have the most asthma-related morbidity and mortality.2  There has been significant innovation in asthma treatments over the past 40 years, including inhaled corticosteroids, leukotriene receptor antagonists, muscarinic antagonists and biologics targeting components of inflammation, such as immunoglobulin E (IgE) and mediators of type 2 (T2) inflammation.3 The success of biologics is leading some specialists to consider for the first time the possibility of asthma remission. Several biologics are approved for asthma in the US – omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab – with others in development.4 Nonetheless an estimated 37-88% of asthma patients have uncontrolled disease.5

The advancing standards of care in asthma follow a change in the global strategy for management and prevention of this disease from the Global Initiative for Asthma (GINA).6  The widely-used GINA strategy report is a global evidence-based approach that can be adapted for local health systems and medicine availability. In GINA track 1, as-needed ICS-formoterol reliever remains the preferred treatment approach for adults and adolescents (Figure 1). The guidance also describes the management of severe asthma and exacerbations, with recommendations on when to use biologics, ICS-formoterol, and ICS-short-acting beta2-agonist (SABA); there is clarification that GINA recommends biologic therapy for asthma only in severe cases and when any existing treatment has been optimized. Single Maintenance and Reliever Therapy (SMART), also known as MART therapy, is used for patients with moderate-to-severe asthma, comprising a combination treatment of an inhaled corticosteroid and a rapid onset LABA such as formoterol.7  An alternative recommendation is the use of ICS whenever albuterol is used as reliever, either in combination or as separate drugs.

Under the new guidelines, steps 1 and 2 together are covered by health insurance in the UK and some European countries, but not in the US, where regulatory barriers from FDA also exist. There is a pressing need for US coverage too, to enable patients to benefit from new and existing treatment options.

Newer products in R&D may have potential for use in steps two and above in the GINA guidelines, including alternative controllers and relievers.

CRISPR technology has potential to delete allergen genes and may therefore help allergy-related conditions such as asthma.8 This approach is being used in combination with a genomic understanding of the human microbiome to help address asthma. A joint project at UC San Francisco and UC Berkeley is using a $70 million grant from a TED initiative to edit the genes of microbes in the gut and airways that play a role in this and other allergic disorders.9 Gene therapy for the disorder itself is primarily for those involving a single gene, so has less potential for asthma, which is a genetically complex disease.

Clinical development of IL-13 therapies for asthma – including lebrikizumab and tralokinumab – has been halted indefinitely due to insufficient efficacy in clinical trials.10 Dupilumab, which affects both IL-4 and IL-13, has been very effective in severe asthma. A study on specific IL-13 therapies concluded that since IL-13 directly affects airway contractility and mucus production, an anti-IL-13 specific drug with demonstrated efficacy could potentially be included before GINA step 5.

Figure 1: GINA asthma management guidelines for adults and adolescents, 202311

US Food and Drug Administration: “We note that recent updates to asthma guidelines recommend the use of an ICS/long-acting beta2-adrenergic agonist (LABA) (formoterol) combination product not only as controller treatment, but also as a preferred reliever treatment for some patients. This is a concept known as SMART – single maintenance and reliever therapy; however, no ICS/LABA product is currently FDA-approved for PRN [as needed] use. FDA does not make recommendations regarding asthma guidelines...”12

In conclusion, the standard of care for asthma is changing for the better, with new guidelines encouraging approaches that are safer, easier and more logical than in the past. This is a major step forward in helping reduce exacerbations, hospitalizations and death related to asthma, and in limiting side-effects due to standard-of-care medications. Biologics – which hold promise in delivering clinical remission in asthma – are the subject of many ongoing research projects. Newer therapies have a particular role in more severe disease, in the later GINA steps, which also use increasing doses of the ICS-formoterol combination. The pressure is on for the US to mirror initiatives in the UK and other European countries to provide regulatory approval and subsequent insurance coverage for these drugs along with much-needed access to care for patients. 


References

1 Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1204–1222. doi:10.1016/S0140-6736(20)30925-9

2 Mortimer K, Reddel HK, Pitrez PM, Bateman ED. Asthma management in low and middle income countries: case for change. Eur Respir J. 2022 Sep 15;60(3):2103179. doi: 10.1183/13993003.03179-2021. PMID: 35210321; PMCID: PMC9474897.

3 Gaston B, Gardner DD, Mahan K, Akuthota P, Mendonca EA, Durrington H, Marozkina N, Martinez-Nunez RT, Newcomb D, Ainsworth B, Owora AH, Chung KF, Walker S, Fowler SJ, Siddiqui S, Winders T, Zein J, Jarjour N, Huang YJ, Cahill KN, Djukanovic R. Asthma innovations from the first International Collaborative Asthma Network forum. ERJ Open Res. 2023 May 30;9(3):00090-2023. doi: 10.1183/23120541.00090-2023. PMID: 37260461; PMCID: PMC10227632.

4 Agache I, Beltran J, Akdis C, et al. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab) for severe eosinophilic asthma. A systematic review for the EAACI Guidelines - recommendations on the use of biologicals in severe asthma. Allergy. 2020 May;75(5):1023-1042. doi: 10.1111/all.14221. Epub 2020 Feb 24. PMID: 32034960.

5 Wang E, Wechsler ME, Tran TN, et al. Characterization of severe asthma worldwide: data from the International Severe Asthma Registry. Chest 2020; 157: 790–804. doi:10.1016/j.chest.2019.10.053

6 Venkatesan P. 2023 GINA report for asthma. Lancet Respir Med. 2023 Jul;11(7):589. doi: 10.1016/S2213-2600(23)00230-8. Epub 2023 Jun 8. PMID: 37302397.

7 Reddel HK, Bateman ED, Schatz M, Krishnan JA, Cloutier MM. A Practical Guide to Implementing SMART in Asthma Management. J Allergy Clin Immunol Pract. 2022 Jan;10(1S):S31-S38. doi: 10.1016/j.jaip.2021.10.011. Epub 2021 Oct 16. PMID: 34666208.

8 Brackett NF, Pomés A, Chapman MD. New Frontiers: Precise Editing of Allergen Genes Using CRISPR. Front Allergy. 2022 Jan 17;2:821107. doi: 10.3389/falgy.2021.821107. PMID: 35386981; PMCID: PMC8974684.

9 University of California San Francisco [Internet]. UCSF; 2023Apr17 [cited 2024Feb15]. Press release. Editing Genes in the Microbiome to Prevent Disease. Available at: https://www.ucsf.edu/news/2023/04/425141/crispring-microbiome-prevent-childhood-asthma

10 Matera MG, Ora J, Calzetta L, Rogliani P, Cazzola M. Investigational anti IL-13 asthma treatments: a 2023 update. Expert Opin Investig Drugs. 2023 May;32(5):373-386. doi: 10.1080/13543784.2023.2215425. Epub 2023 May 18. PMID: 37194672.

11 Global Initiative for Asthma. GINA; 2023Jul12 [cited 2024Feb15]. Web page. Updated: 2023 What’s New in Gina Slide Set. Available at: https://ginasthma.org/wp-content/uploads/2023/08/GINA-2023-Whats-New-Slides-WEBSITE.pptx

12 U.S. Food and Drug Administration [Internet]. FDA; 2022Nov8 [cited 2024Feb15]. Briefing Document. Available from: https://www.fda.gov/media/162912/download

Related solutions

Therapeutic & Specialty Expertise

Specialized expertise and customized solutions across 14 therapeutic centers of excellence, including oncology, GI/NASH, pediatrics, neurology and rare diseases.

Contact Us