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Alan Khadavi, MD, APC
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March 5, 2020 by Alan Khadavi

Asthma biologic agents (Xolair, Cinqair, Nucala, Fasenra, Dupixent)

The last several years have seen an influx of asthma biologic agents to hit the market. Here we will discuss the 5 that are currently FDA approved to treat type 2 inflammatory asthma. Type 2 asthma inflammation is triggered by IL-4, IL-5, and IL-13 along with other inflammatory mediators. Half of all patients with asthma have evidence of Type 2 inflammation. Sputum and blood eosinophils, exhaled nitric oxide, blood IgE levels and airway gene expression markers are frequently used biomarkers to diagnose Type 2 asthma. Individuals tend to have several features of increased asthma severity including reduced lung function and increased rates of asthma exacerbations and Type 2 high patients show airway remodeling and alterations in mucus production.  Several monoclonal antibodies are now available to treat these patients and reduce asthma exacerbation rates.

  1. Xolair (Omalizumab)
  • targets IgE
  • Biomarker is Total IgE 30-700 kU/L (>12 years) or 30-1300 kU/L (6-11 years of age)
  • Originally approved in 2003; now approved for 6 years of age and up
  • Administered subcutaneously every 2-4 weeks, dose based on IgE level and weight
  • clinical outcomes are reduced exacerbations and oral steroid use

2. Cinqair (Reslizumab)

  • Anti-IL-5
  • Biomarker is blood eosinophil >400/uL
  • Approved in 2016 for 18 years and up
  • Administered as an IV infusion 3mg/kg every 4 weeks
  • clinical outcome is reduced exacerbations, especially with rhinosinusitis with nasal polyps.

3. Nucala (Mepolizumab)

  • Anti-IL-5
  • Biomarker is blood eosinophil >150/uL
  • Approved in 2015 for 12 years and up, and now approved for 6 years and up.
  • Administered 40 mg (6-11 years old) or 100 mg (12 years and up), subcutaneously every 4 weeks.
  • outcomes are reduced exacerbations and improved quality of life and lung function.

4. Fasenra (Benralizumab)

  • Anti-IL-5R a
  • Biomarker is blood eosinophil >150/uL
  • Approved in 2017 for 12 and up
  • 30mg SQ every 4 weeks X 3, then every 8 weeks
  • outcomes are reduced exacerbations and improved lung function

5.  Dupixent (Dupilumab)

  • Anti-IL-4ra
  • Biomarker is blood eosinophil >150/uL
  • Approved in 2017 for 12 and up
  • 400 or 600 mg loading dose, then 200 or 300 mg SQ every 2 weeks
  • outcomes are reduced exacerbations and improved quality of life and lung function

These are the current asthma biologic agents available. Type 2 asthma is the most established form of asthma characterized by severe exacerbations and reduced lung function. Blood eosinophil counts are the most established biomarker to establish disease currently.

Nucala vs. Fasenra vs. Cinqair; A Comparison Study

Nucala (mepolizumab) vs. Cinqair (reslizumab)

Costs of Asthma Biologic Medications

Allergy Biologics, Past, Present and Future…

Asthma Biologics, what is their role in asthma?

 

Filed Under: Asthma, biologics, Blog

alan-khadavi
Dr. Alan Khadavi
Allergy & Asthma Specialist

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