Benralizumab (Fasenra) is an interleukin (IL)-5 receptor monoclonal antibody that induces direct, rapid and nearly complete depletion of eosinophils in the circulation. Benaralizumab is approved for use in Canada, Europe, Japan and the U.S. In the United States, it is indicated for the add-on treatment of patients with asthma aged 12 and up with an eosinophilic phenotype. Many insurance companies require the eosinophil count to be 150 and up for it to be approved. Benralizumab has been shown to reduce asthma exacerbations, improve lung function and asthma symptoms.
A recent study published in the Annals of Allergy Asthma and Immunology, titled “Rapid onset of effect of benralizumab on morning peak expiratory flow in severe, uncontrolled asthma”, sought to determine benralizumab’s onset of action and efficacy in morning peak expiratory flow (PEF).
The main conclusions of the study showed that benralizumab produced numerical differences in peak expiratory flow from placebo beginning by day 2 after the first dose, with meaningful improvements observed within 3 weeks for patients with severe uncontrolled asthma.
Benralizumab is initially given every 4 weeks for the first 3 doses, and then it is given every 8 weeks. Based on this study, patients should expect to see improvement after even the first dose. There are currently 5 asthma biologic medications on the market. Xolair which was the first one approved, is indicated for allergic asthma. The others are:
New Asthma Drug Nucala (Mepolizumab) for Severe Eosinophilic Asthma
Cinqair (Reslizumab) for Eosinophil Disorders (formerly Cinquil)
Dupilumab for Asthma, a New Indication
It can be difficult to determine which asthma medication is best for which patient. There are very limited head to head studies, also the costs of them are very high.
Nucala vs. Fasenra vs. Cinqair; A Comparison Study
Nucala (mepolizumab) vs. Cinqair (reslizumab)
Costs of Asthma Biologic Medications
There will be more asthma biologics coming out in the near future too. It will be important to tailor which medication is right for which asthmatic patient. Unfortunately for some of these medications, there are biomarkers that are not commercially available to measure. For instance, Dupixent targets IL 4 & IL 13, but there no commercial labs which test for levels of it.
Allergy Biologics, Past, Present and Future…
More studies and more medications will come out that will help patients and doctors pick the right and best asthma medication.