Biologic therapy for severe asthma

Overview

Biologic therapies represent innovative treatments that target specific molecules in the body involved in asthma. These injectable medications are made to ease symptoms and improve asthma management for patients who haven’t found enough relief from standard inhaler treatments. Particularly advantageous for individuals with severe asthma experiencing frequent symptoms or exacerbations despite using multiple inhalers, biologic therapies such as omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab offer promising benefits. However, their use requires careful consideration of potential side effects when determining the most suitable treatment approach.

Types

Several biologic therapy medications are known for treating severe asthma, such as:

• Omalizumab: Omalizumab is a medication used for patients with poorly controlled asthma who also have allergies to year-round allergens such as dust mites, pet dander, or cockroach debris. It works by blocking the antibody responsible for triggering allergic asthma responses.

Omalizumab is administered via subcutaneous injections, typically one or two depending on the prescribed dose, and the injections are given every 2 or 4 weeks. After receiving the medication, a monitoring period is required to watch for any potential reactions to the medication.

The common side effects of omalizumab include muscle and joint aches, fatigue, injection site reactions, and rarely, severe allergic reactions.

• Mepolizumab: This medication designed for patients with eosinophilic asthma. Eosinophils, a type of white blood cell, can trigger lung inflammation in certain asthma patients. It works by lowering the eosinophil count in the blood. Mepolizumab is given as an injection under the skin once every 4 weeks. Following each dose, patients will be monitored for a period to ensure there are no adverse reactions to the medication.

The common side effects of mepolizumab include headaches, injection site reactions, back pain, weakness, fatigue, and rarely, severe allergic reactions.

• Reslizumab: Reslizumab is used to treat eosinophilic asthma by decreasing eosinophil levels in the blood.

This medication is administered via intravenous infusion over 20 to 50 minutes once every 4 weeks and requires monitoring afterward for potential reactions.

The most common side effects of reslizumab include sore throat and muscle aches, with severe allergic reactions occurring rarely.

• Benralizumab: Benralizumab is a medication used for patients with eosinophilic asthma, targeting a type of white blood cell called eosinophils to decrease their number in the bloodstream.

It is given as a subcutaneous injection, initially every 4 weeks for the first 3 doses, and then every 8 weeks thereafter. Following each administration, observation is necessary to ensure there are no adverse reactions to the medication.

The most common side effects of benralizumab include headache and sore throat, with severe allergic reactions being rare.

• Dupilumab: Dupilumab is given via subcutaneous injection every other week. It treats poorly controlled eosinophilic asthma by blocking inflammatory cells affecting asthma patients.

The first three doses are administered in clinic for training on self-injection, with a one-hour monitoring period after the first dose and 30 minutes after the subsequent two doses to watch for any reactions. Following this initial phase, dupilumab can be self-administered at home.

The most common side effects of dupilumab include sore throat, temporary redness or pain at the injection site, elevated eosinophil levels, and rarely, severe allergic reactions.

Outcome

Healthcare providers assess the appropriateness of these therapies by evaluating the patient’s symptoms, current medication regimen, and results from blood tests. Regular and consistent use of all prescribed asthma medications and inhalers is crucial. Healthcare providers will also guide patients on any necessary adjustments to inhaler doses as their asthma becomes well-managed.