II. 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
III. Adverse Effects
-
Anaphylaxis risk with all agents (several of the agents have a reported 0.2% risk)
- Consider prescribing Epinephrine injector
IV. Disadvantages
- $2500 to $4500 per month
V. 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)
- References
VI. 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
VII. 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
VIII. 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
IX. Management: Monitoring
- Re-evaluate every 3-6 months
- Taper off oral Corticosteroids and other add-on management
X. Resources
- Biologic Therapy in Asthma
XI. References
- (2018) Biologics for Asthma, Presc Lett
- Narasimhan (2021) Am Fam Physician 103(5): 286-90 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129) |
| MSH | C434107 |
| English | mepolizumab |
Ontology: reslizumab (C1869620)
| Concepts | Immunologic Factor (T129) |
| MSH | C515492 |
| English | reslizumab |
Ontology: benralizumab (C2982078)
| Definition (NCI) | An afucosylated, humanized monoclonal antibody against the alpha chain of the interleukin-5 receptor (IL-5Ra), with potential anti-asthmatic activity. Upon administration, benralizumab binds to IL-5Ra and elicits an antibody-directed cell cytotoxicity (ADCC) against IL-5Ra-expressing cells. This induces apoptosis in IL-5Ra-expressing cells and may reduce asthmatic episodes. IL-5Ra, expressed on both eosinophils and basophils, plays a key role in asthma. |
| Concepts | Immunologic Factor (T129) , Pharmacologic Substance (T121) |
| MSH | C571386 |
| English | BIW-8405, Anti-CD125 Humanized Monoclonal Antibody, IgG1-kappa, KHK-4563, Benralizumab, MEDI-563, benralizumab, BENRALIZUMAB |
