Strategies for improving the efficacy and therapeutic ratio of glucocorticoids

Curr Opin Pharmacol. 2012 Jun;12(3):246-51. doi: 10.1016/j.coph.2012.02.006. Epub 2012 Mar 23.

Abstract

Although glucocorticoids are very effective in suppressing inflammation there is a clear clinical unmet need for new or improved glucocorticoids in patients with severe asthma and COPD. Recent developments include the targeted deposition of ultrafine glucocorticoid particles to treat small airways and the potential of novel agents that have a reduced side effect profile. Understanding the drivers of relative glucocorticoid resistance in these patients may lead to the development of newer drugs aimed at subsets of patients, for example asthmatics with high periostin levels. Alternatively, inhibitors of kinase pathways that are associated with inflammatory responses may be able to modulate glucocorticoid function and combinations of these inhibitors along with novel glucocorticoids may provide the combination therapy of the future.

Publication types

  • Review

MeSH terms

  • Animals
  • Anti-Asthmatic Agents / adverse effects
  • Anti-Asthmatic Agents / pharmacology
  • Anti-Asthmatic Agents / therapeutic use
  • Anti-Inflammatory Agents / adverse effects
  • Anti-Inflammatory Agents / pharmacology
  • Anti-Inflammatory Agents / therapeutic use*
  • Asthma / drug therapy
  • Asthma / immunology
  • Asthma / metabolism
  • Drug Therapy, Combination
  • Drugs, Investigational / adverse effects
  • Drugs, Investigational / pharmacology
  • Drugs, Investigational / therapeutic use
  • Glucocorticoids / adverse effects
  • Glucocorticoids / metabolism
  • Glucocorticoids / pharmacology
  • Glucocorticoids / therapeutic use*
  • Humans
  • Immune System / drug effects
  • Immune System / metabolism
  • Immune System / physiopathology
  • Lung / drug effects
  • Lung / metabolism
  • Lung / physiopathology
  • Molecular Targeted Therapy*
  • Protein Kinase Inhibitors / adverse effects
  • Protein Kinase Inhibitors / pharmacology
  • Protein Kinase Inhibitors / therapeutic use
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / immunology*
  • Pulmonary Disease, Chronic Obstructive / metabolism

Substances

  • Anti-Asthmatic Agents
  • Anti-Inflammatory Agents
  • Drugs, Investigational
  • Glucocorticoids
  • Protein Kinase Inhibitors