II. Indications

  1. Third-line agents for inadequately controlled severe Eosinophilic Asthma
    1. Despite long acting Bronchodilator and Inhaled Corticosteroids

III. Adverse Effects

  1. Anaphylaxis risk with all agents (several of the agents have a reported 0.2% risk)
    1. Consider prescribing Epinephrine injector

IV. Disadvantages

  1. $2500 to $4500 per month

V. Preparations: Interleukin-5 Antagonist (alpha-directed cytolytic Monoclonal Antibody, IgG1 Kappa)

  1. General
    1. May be used in age >=12 years old U.S. (>=18 years old Canada)
  2. Benralizumab (Fasenra)
    1. Dose 30 mg SQ every 4 weeks for 3 doses, then every 8 weeks
    2. Uncommon Headache, Pharyngitis
  3. Mepolizumab (Nucala)
    1. Dose 100 mg SQ q 4 weeks
    2. Common Headache, uncommon injection site irritation, back pain ,Fatigue

VI. Preparations: Interleukin-5 Antagonist (Monoclonal Antibody, IgG4 Kappa)

  1. General
    1. May be used in age >=18 years old
  2. Reslizumab (Cinqair)
    1. Dose 3 mg/kg IV infusion over 20-50 min every 4 weeks
    2. Uncommon Pharyngitis

VII. Preparations: Anti-IgE Antibody

  1. General
    1. May be used in age >=6 years old (if positive skin test or RAST to perennial allergen)
  2. Omalizumab (Xolair)
    1. Dose 75 to 375 mg SQ every 2-4 weeks (variable dose based on age, weight, serum IgE)
    2. Uncommon Arthralgias

IX. References

  1. (2018) Biologics for Asthma, Presc Lett

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Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Immunologic Factor (T129)
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Ontology: reslizumab (C1869620)

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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)
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