Treating Severe Asthma With Biologics

How Biologics Treat Asthma, Types, and Their Side Effects

For many people who live with asthma, their symptoms are managed by identifying and avoiding triggers, taking daily oral medications, and using a quick relief inhaler. However, for some people, these measures aren’t enough to manage their day-to-day asthma symptoms, and they need stronger medications. This is the case for 5% to 10% of the people living with asthma.

In recent years, new drugs called biologics have been approved for treating moderate-to-severe asthma. Biologics target specific antibodies (blood proteins) responsible for causing asthma.

What Are Biologics?

Biologics are powerful medicines made of tiny components, including sugars, proteins, DNA, whole tissues, or cells. They come from all sorts of living sources—mammals, insects, plants, bacteria, and more.

Biologic drugs are the latest and most advanced treatments available today. Many of these are making it possible to treat illnesses that previously were considered untreatable. But because these drugs come from a variety of sources, they are more complicated. In fact, they take a lot more work to produce, and once they are formulated, they more susceptible to light and temperature and should be managed safely and kept correctly.

How Biologics Help With Asthma

Doctors will prescribe biologics for people with severe asthma whose symptoms aren’t being controlled by inhaled corticosteroids, short-acting beta agonists, and other standard asthma medications. A biologic drug can help to manage shortness of breath and coughing. It may also reduce and prevent asthma attacks and lessen the intensity of attacks that do happen. When given for people with asthma, these drugs work by targeting different molecules and proteins in the body that contribute to symptoms.

According to a 2016 report in the journal Current Opinion in Allergy and Clinical Immunology, the primary benefit of biologics is to decrease frequently of “asthma exacerbations, emergency room visits, hospitalizations, and need for oral steroids.” Further, biologics can improve life quality for people with the condition, and some biologics have even improved lung function in people with severe asthma.

Biologic Types for Severe Asthma

There are two types of biologic drugs that are approved for the treatment of severe asthma. One targets immune system protein called immunoglobulin E (IgE), and the other treats eosinophilic asthma.

IgE is naturally produced by B cell lymphocytes—a type of white blood cell—when fighting off infection. IgE also increases when someone is exposed to an allergen and triggers an allergic reaction, which may include asthma. Asthma that is caused by allergen exposure is called allergic asthma.

Eosinophilic asthma (EA) is a severe kind of asthma, marked by high white blood cell levels. These cells—called eosinophils—usually fight infections and bacteria. However, in people with EA, they cause inflammation and swelling in the airways and respiratory system.

The more eosinophils cells there are, the more severe asthma symptoms will be. But EA is rare, only affecting about 5% of adults with asthma. Unfortunately, EA is also difficult to treat and can significantly alter a person’s quality of life.

Recognizing the symptoms of EA—which many include obstructed airflow, shortness of breath, chronic sinus infections, and nasal polyps—can help your doctor find effective treatments to help reduce complications. 

Biologic Therapy Drugs

There are many new biologic therapy options available to treat severe asthma. They work by targeting different proteins in the body that contribute to asthma symptoms.

Xolair (omalizumab): Xolair was approved in 2016 by the U.S. Food and Drug and Administration (FDA) for adults and children ages 6 and up. It works by blocking IgE proteins on immune cells and prevents them from releasing their chemicals. The medication is available as an injection taken once or twice a month. Studies show it can reduce the number of asthma attacks, prevent hospitalizations, and reduce the need for other asthma treatments, especially steroids.

Dupixent (dupilumab): Doctors prescribe Dupixent for people with eosinophilic asthma that is poorly controlled. It works by blocking inflammatory cells responsible for asthma symptoms. The medication is available as a once a week injection. The first few doses are usually administered by your doctor’s office and you will be monitored for any adverse reactions within the first hour. After the initial doses, you can administer the injections at home on your own.

Nucala (mepolizumab): Nucula is prescribed for people with eosinophilic asthma. The medication is available as an injection to be taken every four weeks.

Fasenra (benralizumab): Fasenra is prescribed for treating eosinophilic asthma and works by reducing the number of eosinophils in the blood. It is an injection treatment, given every four weeks for the first three doses, and then taken once every eight weeks.

Cinqair (reslizumab): Cinqair is often prescribed for eosinophilic asthma. Similarly to other biologics for asthma, it works to reduce the number of eosinophils blood cells. It is given as an intravenous (IV, or through the vein) infusion once every four weeks. Infusion treatments are usually done at an infusion center. After you receive a dose of medication, the staff at the infusion center will monitor you for a period of time to make sure you don’t have any adverse reactions to the medications.

Your doctor is the best position to decide what biologic therapies can help manage your asthma based on your symptoms, medications you currently take, and blood test results. You will still need to take other asthma medications and use your rescue inhalers, although it is possible your doctor may reduce medication doses once asthma is under control.

Side Effects of Biologics

Biologic drugs are generally safe, but side effects are possible. Side effects of biologic drugs depend on the specific drug and the way in which it is administrated.

While rare, some biologic drugs can cause allergic reactions called anaphylaxis, which may include:

  • Hives or a rash 
  • Swelling in the face, mouth, or tongue
  • Shortness of breath
  • Low blood pressure
  • Wheezing
  • Problems with swallowing
  • Dizziness and/or fainting

Other biologics can increase a person’s risk for infections. Biologics given by injection can cause injection site irritation or swelling, while biologics given by IV can cause infusion reactions.

Injection site reactions may include redness, swelling, pain, and itching. Infusion reactions include pain, swelling, redness at the IV site, headache, flushing, nausea, and rash.

Other common side effects of biologics include:

  • Cold-like symptoms
  • Headaches
  • Fatigue
  • Nausea
  • Sinus infection

A Word From Verywell

Biologic therapy may not work for everyone and it may require the use of other treatments as well. It is likely your doctor will initially introduce a biologic to treat your asthma as part of your treatment plan to see if it helps manage symptoms. If you are able to find a biologic that works for you, this may cut down the number of attacks you experience. It is also possible that you may eventually be able to cut back on the number of other treatments you take, including corticosteroids.

Biologic drugs are expensive and may cost thousands of dollars per year. Because of the high cost, your doctor will try to work with your insurance company to make sure a biologic is covered prior to your starting the treatment. And it may take a few months to see if the biologic is helping. Your doctor will give you a timeframe for how long you will be on a biologic if your asthma is under control.

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Article Sources

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