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Asthma Monoclonal Antibody

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Asthma Monoclonal Antibody, Asthma Biologic, Benralizumab, Fasenra, Mepolizumab, Nucala, Reslizumab, Cinqair

  • Indications
  1. Third-line agents for inadequately controlled severe Eosinophilic Asthma
    1. Despite long acting Bronchodilator and Inhaled Corticosteroids
  • Adverse Effects
  1. Anaphylaxis risk with all agents (several of the agents have a reported 0.2% risk)
    1. Consider prescribing Epinephrine injector
  • Disadvantages
  1. $2500 to $4500 per month
  • 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
  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
  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
  • References
  1. (2018) Biologics for Asthma, Presc Lett