Omalizumab(Xolair) has been approved for moderate-severe asthma in patients >6 years of age. This drug binds free serum IgE in allergic asthma patients that have failed aggressive therapy. This includes inhaled corticosteroids, short and long acting bronchodilators, anticholinergics, montelukast and frequent bursts of systemic corticosteroids. Xolair is given subcutaneously in our office every 2-4 weeks. The dose and interval depends on the patient’s weight and IgE level.
IN 2017, 3 new biologic monoclonal antibodies became available to treat moderate to severe persistent asthma. They all target Interleukin-5(IL-5) as inhibitors to decrease production of an inflammatory white blood cell called eosinophils.
1. Mepolizumab(Nucala) was approved for >12 years of age in patients with peripheral eosinophil counts > 150mg/dL. Patients are given 100mg subcutaneously in our office every 4 weeks. (See previous blog from Feb/’17).
2. Reslizumab(Cinqair) was the 2nd IL-5 inhibitor approved for >18 year old asthmatics by the FDA in 2017. A peripheral eosinophilic count of >400mg/dL is required. This drug is given at 3mg/kg IV every 4 weeks. We use Dent Infusion center for administration of this drug.
3. Benralizumab(Fasenra) was the latest IL-5 inhibitors approved. This drug targets the IL-5 receptor and is also given subcutaneously in >12 year old asthmatics. The dosage is 30mg every 4 weeks x 3, then every 8 weeks. It is also given in our office.
Dr Rockoff and his staff will determine which patients are eligible for IL-5 inhibitor therapy. Side effects are rare, but reported. All patients receiving these meds will be given epinephrine injectors for potential anaphylactic reactions. All side effects and appropriate therapy will be reviewed prior to initiating monoclonal therapy. Prior authorization from the patient’s insurance is also mandatory. Significant clinical improvements including decrease asthma flares, nocturnal awakenings, use of rescue and systemic corticosteroids should be seen within 6-12 months. Many of our patients have seen a tremendous improvement within the 1st 3 injections. The future of IL-5 inhibition may also include treating nasal polyps and other eosinophilic diseases such as eosinophil esophagitis.