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Asthma Monoclonal Antibody
Aka: Asthma Monoclonal Antibody, Asthma Biologic, Interleukin-5 Antagonist, IL-5 Antagonist, Benralizumab, Fasenra, Mepolizumab, Nucala, Reslizumab, Cinqair, Interleukin-4 Alpha Receptor Antagonist, Dupilumab, Dupixent
- See Also
- Severe Persistent Asthma
- Omalizumab (Xolair)
- Indications
- Third-line agents for refractory, Type 2 Asthma (Allergic Asthma or Eosinophilic Asthma, represents 50% of Asthma)
- Despite long acting Bronchodilator and Inhaled Corticosteroids
- One of the following findings present
- Blood Eosinophils >150/uL
- Sputum Eosinophils >2%
- Ferrous Nitrous Oxide >20 parts per billion
- Maintenance oral Corticosteroids required
- Adverse Effects
- Anaphylaxis risk with all agents (several of the agents have a reported 0.2% risk)
- Consider prescribing Epinephrine injector
- Disadvantages
- $2500 to $4500 per month
- Preparations: Interleukin-5 Antagonist (alpha-directed cytolytic Monoclonal Antibody, IgG1 Kappa)
- General
- May be used in age >=12 years old U.S. (>=18 years old Canada)
- Benralizumab (Fasenra)
- Dose 30 mg SQ every 4 weeks for 3 doses, then every 8 weeks
- Uncommon Headache, Pharyngitis
- Mepolizumab (Nucala)
- Dose 100 mg SQ q 4 weeks
- Common Headache, uncommon injection site irritation, back pain ,Fatigue
- References
- Ortega (2014) N Engl J Med 371(13): 1198-207 [PubMed]
- Preparations: Interleukin-5 Antagonist (Monoclonal Antibody, IgG4 Kappa)
- General
- May be used in age >=18 years old
- Reslizumab (Cinqair)
- Dose 3 mg/kg IV infusion over 20-50 min every 4 weeks
- Uncommon Pharyngitis
- References
- Nair (2017) N Engl J Med 376(25): 2448-58 [PubMed]
- Preparations: Interleukin-4 Alpha Receptor Antagonist
- General
- May be used in age >= 6 years old
- Dupilumab (Dupixent)
- Adult Dose: 600 mg SQ once, then 300 mg SQ every 2 weeks
- References
- Castro (2018) N Engl J Med 378(26):2486-96 [PubMed]
- Rabe (2018) N Engl J Med 378(26): 2475-85 [PubMed]
- Preparations: Anti-IgE Antibody
- General
- May be used in age >=6 years old (if positive skin test or RAST to perennial allergen)
- Omalizumab (Xolair)
- Dose 75 to 375 mg SQ every 2-4 weeks (variable dose based on age, weight, serum IgE)
- Uncommon Arthralgias
- Management: Monitoring
- Re-evaluate every 3-6 months
- Taper off oral Corticosteroids and other add-on management
- Resources
- Biologic Therapy in Asthma
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405559/
- References
- (2018) Biologics for Asthma, Presc Lett
- Narasimhan (2021) Am Fam Physician 103(5): 286-90 [PubMed]