Nucala (mepolizumab) is a new drug used as an anti-Interleukin 5(IL-5) therapy for severe persistent asthma. It targets eosinophils which are major inflammatory cells in our bodies contributing to asthma and asthma flareups.
Nucala is approved for 12 years of age and above. It is not indicated for relief of bronchospasm during an asthma exacerbation. It is also not indicated for other eosinophilic diseases such as Allergic Rhinitis, Nasal Polyps, Gastroesophageal diseases, Hypereosinophilia, etc.
Patients must meet certain criteria to have this drug prior approved by their insurance. Documentation of multiple asthma flares despite compliance with a maintenance high dose inhaled corticosteroid as well as adjunct therapy including oral/systemic steroid bursts must be reported. Pre-therapy CBC/Differential labs must show a total eosinophilic count of >150.
The approved dose of Nucala is 100mg subcutaneously every 4 weeks. It is given in our office under supervision of our staff. Patients are observed for 1 hour after their first injection and 30 minutes after each subsequent injection. Beneficial clinical responses with decreased asthma flares, use of rescue inhalers, ER/Hospital visits and Prednisone bursts should be noted within a few months. However, some studies suggest 6-12 month trials before noted benefit is seen.
Common side effects include local site reactions with redness, itching and swelling. Headaches, back pain, fatigue and itchy(non site ) reactions have been less commonly noted. Rare systemic reactions have also been reported. All patients are given and trained on use of either Epipen, Auvi-Q or Adrenaclick which should be carried for 24 hours after each injection.
Whether patients are candidates for Nucala(mepolizumab), Cinqair(Reslizumab) or Xolair(Omalizumab) should be discussed with Dr Rockoff.