Xolair vs. Nucala vs. Dupixent
Multiple biologics are approved for the the treatment of severe asthma. However, there are no head to head studies comparing them. Many patients can potentially be approved for multiple of them and it can be difficult to choose which would work best. So the optimal choice may be uncertain.
All currently approved asthma biologic therapies have been shown to improved asthma-related outcomes in patients who are not controlled with conventional therapies.
- Xolair (omalizumab) is an anti-IgE that is approved for allergic asthma who have sensitivity to perennial allergens and their IgE level is between 3-700 kU/L.
- Dupixent (dupilumab) is an anti IL-4 receptor alpha for patients with allergic and eosinophilic asthma.
- Nucala (mepolizumab) is an anti-IL-5 that is effective in eosinophilic asthma in patients whose eosinophils are at least 150 cells/microliter.
Without head to head studies it is hard to make an effective clinical decision. A recent study reported in the Journal of Allergy and Clinical Immunology performed a retrospective clinical study of all 3 of them and compared asthma-related exacerbations and improving lung function in individuals with asthma.
The conclusions of the study found:
- Dupixent was associated with greater reductions in exacerbations that Nucala and Xolair.
- Dupixent was associated with greater than 100ml improvement in FEV1 value compared with Nucala, although this did not meet statistical significance threshold.
In past articles we have discussed other head to head studies.
There are many factors involved when choosing the right biological medication for asthma, co-morbid conditions also play a role, although in this study those patients were not included.
If you suffer from asthma that isn’t well controlled with maintenance asthma inhalers, speak to your doctor or asthma specialist about other treatment options.