Most cases of asthma are well-managed with standard therapies. Standard therapies usually consist of identifying and avoiding triggers, taking controller medication, and using a quick-relief inhaler when symptoms develop. Some individuals, however, do not respond to standard therapies. A new class of medications called ‘biologic therapies’ have been developed to target unique pathways responsible for inflammation in moderate-to-severe asthma when standard therapies are ineffective.
Biologic therapies are unique in that they target a specific antibody, inflammatory molecule, or cell receptor, so an asthma patient may respond more favorably to one type of biologic over another. Where patients with moderate-to-severe asthma would otherwise experience frequent symptoms, biologics have been shown to decrease the frequency of asthma exacerbations, requiring less emergency room visits, less hospitalizations, and fewer interventions with oral steroids. Additional benefits include reduced asthma symptoms, improved lung function, reduced dosage of other controller medication, and less missed school and work days. Patients on biologics have told us that they are more confident in going out and meeting people, are more mobile, and much less stressed about flare ups.
Getting Started with Biologics
If you’re having a difficult time keeping your asthma under control, you should start by discussing your situation with Dr. Beerelli. If you’re a good candidate for biologics and decide to proceed with treatment, you will still need to take your usual medicines, including your inhalers, even if you are on a biologic therapy. It’s also important that you’ve been following your standard treatment plans, and taking your prescribed medicines properly even if you feel they’re not very effective.
Biologics are made from the cells of a living organism that is then modified to target specific molecules in humans. Unlike other medications for asthma, most biologics are administered in Dr. Beerelli’s office either as a subcutaneous injection or as an intravenous infusion. Injection visits are usually required every two to eight weeks depending on your regimen. With some biologics, Dr. Beerelli may want to observe you in the office for 30 minutes up to two hours after administration to minimize any unforeseen side effects. Dupilumab is the one biologic that can be self-administered at home.
If your asthma does not improve after receiving 4 to 12 months of a biologic treatment, or you have been unable to reduce your daily steroid use, Dr. Beerelli will reassess your asthma and you may be offered another biologic treatment. If you have a successful trial, Dr. Beerelli will develop a personalized plan for you to continue long-term treatment.
Approved Biologics for Asthma
A handful of biologic therapies have been FDA approved for asthma.
Xolair (Omalizumab) – Indicated for severe allergic asthma. Omalizumab works by reducing the amount of IgE in the body. IgE is produced when a person has an allergic reaction, too much of which can cause inflammation in the lungs. Omalizumab is given as an injection every 2 to 4 weeks.
Nucala (Mepolizumab) – Indicated for eosinophilic asthma. Mepolizumab works by reducing the number of eosinophils (a type of white blood cells) in the body, lowering the inflammation that can cause asthma symptoms and attacks. Mepolizumab is usually injected every 4 weeks.
Cinqaero (Reslizumab) – Also Indicated for eosinophilic asthma. Reslizumab works by reducing the number of eosinophils (a type of white blood cells) in the body, lowering the inflammation that can cause asthma symptoms and attacks. Reslizumab is usually injected every 4 weeks.
Fasenra (Benralizumab) – Also Indicated for eosinophilic asthma. Benralizumab works by reducing the number of eosinophils (a type of white blood cells) in the body, lowering the inflammation that can cause asthma symptoms and attacks. Benralizumab is injected every 4 weeks for the first 3 doses and then every 8 weeks afterwards.
Side Effects of Biologics
A very small percentage of patients experience side effects from biologic injections. Some biologics carry a small risk of anaphylaxis, so your allergist will typically prescribe an epi pen in case of severe reaction. Biologics can also interact adversely with certain types of parasitic infections or with herpes zoster (the virus responsible for chickenpox in children and shingles in adults). More common but much less significant side effects include minor irritation at the injection site, headaches, tiredness, sore throat, and other cold-like symptoms. Overall, studies have shown biologics to be very safe.