Cinqair (formerly Cinquil) (Reslizumab) is currently in the pipelines to treat eosinophilic disorders. The main treatment goal for Cinqair will be eosinophilic asthma. Nucala was approved previously for eosinophilic asthma, see link below. Cinqair was recently FDA approved for patients 18 years and older. It will be administered every 4 weeks by IV infusion and it will be dosed every 3 mg/kg. It should be available later this year, 2016.
Eosinophils are responsible for a host of allergic disorders such as allergic asthma, eosinophilic esophagitis and Hyper IgE syndrome, to name a few.
The activation and maintenance of eosinophils is dependent on the cytokine IL-5, so by blocking IL-5, this would lead to the disrupting the maturation and survival of eosinophils. Cinqair (formerly Cinquil) (Reslizumab) is a humanized anti-IL 5 blocking antibody. This would lead to less eosinophils being made. The role of Cinqair (formerly Cinquil) (Reslizumab) would be to treat patients with moderate to severe asthma with high eosinophil counts.
A recent study was published that showed asthma patients treated with Cinqair (Reslizumab) had a reduction in asthma exacerbation and improvements in multiple measures of asthma control. Cinqair (Reslizumab) could be used for add on therapy for moderate to severe asthmatic patients not controlled with inhaled corticosteroids. These patients would have be selected by having elevated eosinophil counts which could be detected from a blood test.
Cinqair (formerly Cinquil) (Reslizumab) is still in the research phase, so do not expect it anytime soon on the market. More likely we will be seeing Nucala (mepolizumab) before Cinqair (Reslizumab). They both target IL-5, so it will be interesting to see what the differences will be between both medications.
Cinqair (Reslizumab) and Nucala (Mepolizumab) will most likely both be approved for asthma, but there are other eosinophil disorders such as eosinophilic esophagitis that they may be approved for. When Xolair first came on the market its only indication was for asthma, but later it got approval for chronic idiopathic urticaria.
We are currently seeing great results with this medication for patients who have chronic hives. So look for other eosinophil indications for Cinqair (Reslizumab) if it reaches the market for asthma.
The FDA is expected to make a ruling on whether or not Cinqair (Reslizumab) gets approval in March 2016. The US regulator has accepted Cinqair (Reslizumab) for application of asthma attacks despite inhaled corticosteroids and elevated eosinophil accounts. We will keep you updated on that decision.
Since this article was written, Nucala (mepolizumab) has been approved and Cinqair (reslizumab) should be getting FDA approval soon too. There will never likely be any studies comparing head to head Cinqair (reslizumab) vs. Nucala (mepolizumab), or Cinqair vs. Xolair (omalizumab). It would be up to your allergy doctor to decide which is right for you. A similar comparison would be Advair, Dulera and Symbicort. They are all inhaled corticosteroids with a long acting beta agonist. They are in the same class and all do well. If you are deciding which one to use, price, insurance coverage will all be a factor in picking Cinqair (reslizumab) or Nucala (mepolizumab). Teva which is manufacturing Cinqair will have a patient support system to help get coverage for the medication. Because it will be given as an IV infusion, there may be more logistic issues for its administration, the other biologic asthma medications, (Xolair and Nucala) are given subcutaneously in an allergists office. There is a chance in the future that Cinqair will also be approved for subcutaneous injection, but for now it is intravenous only.
It is dosed 3 mg/kg IV infusion every 4 weeks. Depending on a patients weight, 2-4 vials may be needed to be mixed with normal saline. A typical infusion will take 20-50 minutes. There is a 0.3 percent chance of anaphylaxis, so a patient needs to be carefully monitored during and after an infusion. It became available April 28, 2016.
The cost of Cinqair is similar to other biologics in the same category. Because Cinqair is dosed by weight, the price can be different for patients on the medication. Each vial costs approximately $800. So depending on how many vials are needed, it can cost between $1600-$3200 dollars a month. These are just approximate costs, depending on your insurance, patient discounts and which pharmacy it is purchased from.
There is no set criteria based on the eosinophil count like Nucala. The indications for Cinqair just state “an eosinophilc phenotype” for patients with severe asthma aged 18 years and older. But if we go by their studies, in general the absolute eosinophil count should be 400 cells/ul or greater.
To calculate the eosinophil count on a CBC, you multiply the percentage of eosinophils by the total WBC. On some CBC results, the calculation is already done for you as well.
There is no head to head data of Cinqair vs. Nucala. There likely will never be a study comparing both of these medications. They are both for severe eosinophilic asthma, some of the data is slightly different overall, but nothing major sets either of these apart at the present time. As allergists gain more experience with both medications, time will tell if one of them works better than the other.
A recent study published in Chest, took patients with poorly controlled asthma and were given reslizumab, without regard to their eosinophil count. The strategy did not work, only subjects with eosinophilia of 400 cells or greater showed benefits. Anti IL-5 therapy with reslizumab only works well if the eosinophil count is high.