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

Franziska Roth-Walter, Ian M. Adcock, Cristina Benito-Villalvilla, Rodolfo Bianchini, Leif Bjermer, Gaetano Caramori, Luigi Cari, Kian Fan Chung, Zuzana Diamant, Ibon Eguiluz-Gracia, Edward F Knol, Antonios G.A. Kolios, Francesca Levi-Schaffer, Giuseppe Nocentini, Oscar Palomares, Pier Giorgio Puzzovio, Frank A Redegeld, Betty C.A.M. van Esch, Cristiana Stellato*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

32 Scopus citations


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.

Original languageAmerican English
Pages (from-to)432-448
Number of pages17
JournalAllergy: European Journal of Allergy and Clinical Immunology
Issue number3
StatePublished - Mar 2019

Bibliographical note

Publisher Copyright:
© 2018 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.


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


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