Investigational anti IL-13 asthma treatments: a 2023 update

Introduction: IL-13 is a pleiotropic type 2 cytokine important in the pathogenesis of asthma and other eosinophilic disorders. Areas covered: Different attempts to directly neutralize IL-13 or block its receptors and the possible impact that these approaches may have in the treatment of asthma. Expert opinion: Collectively, specific anti-IL-13 agents are ineffective in treating severe asthma. Lebrikizumab and tralokinumab, the two most widely studied anti-IL-13 monoclonal antibodies, did not show any statistically significant improvement in quality of life or reduction in asthma exacerbation and/or symptoms in phase III studies. Consequently, their clinical development for the treatment of patients with asthma has been halted indefinitely. Other attempts to block or, at least limit, the impact of IL-13 in asthma, such as the use of protein-protein interaction modulators, kinase inhibitors, bispecific antibodies, or IL-13 peptide vaccines, are largely still in the preclinical stage of development, and it is difficult to predict whether they will reach clinical development. Nevertheless, since IL-13 directly affects airway contractility and is critical for mucus production and remodeling, and airflow limitation and mucus hypersecretion are commonly treatable features in asthma, we suggest including an anti-IL-13 drug before GINA step 5.