Will Biologics Help Your Asthma?

Nurse giving injection to patient

fstop123 / Getty Images

In This Article

Biologics (a.k.a. immunomodulators or monoclonal antibodies) are a class of asthma medication that address the inflammatory response that is responsible for asthma symptoms. These drugs may be indicated for difficult-to-treat asthma cases, offering some hope of better asthma control for the nearly 10% of people with asthma who either do not respond to inhaled steroids or have a poor response to them.

Biologics for asthma are not taken alone. As an add-on therapy, a biologic is a controller medication rather than a short-acting medication for the acute relief of asthma symptoms.

These particular medications for asthma are monoclonal antibodies created from living organisms (hence the name "biologic"), though biologics exist for other conditions like cancer and rheumatoid arthritis.

How Biologics for Asthma Work

To understand biologic treatment for asthma, you must first understand its pathogenesis, or how the disease starts and progresses.

Asthma is a chronic inflammatory lung condition where an outside stimulant (usually an allergen) triggers an abnormal immune response in the body that causes airways to constrict, bronchial muscles to spasm, and mucus to accumulate. This brings chest tightness, breathing difficulty, coughing, and wheezing. In severe cases, these symptoms can be life-threatening.

Biologics used for asthma go about treatment in a different way than the usual first-line options. Inhaled or oral corticosteroids, for example, are commonly used by asthmatics to open airways and control symptoms, but some patients don't respond to that therapy. Biologics target the inflammatory response itself.

What They Target

During an asthma attack, inflammation travels along different pathways to have an effect on the lungs. A variety of substances and triggers in the immune response deliver a cascade of reactions to produce symptoms.

Some key actors in this process that can be mitigated by biologic treatment include:

  • Immunoglobulin E (IgE), an antibody overproduced during an allergic reaction's immune respons: People with allergic asthma have higher levels of IgE than the general population.
  • Cytokines: These are signal molecules in the immune response. For severe asthma, the cytokines interleukin-4, -5, and -13 (IL-4, -5, -13) are major factors in the cascade response of symptoms. 
  • Eosinophils, a type of white blood cell: A higher-than-normal eosinophil count indicates an inflammatory condition such as allergic asthma. Interleukin cytokines, in particular, are involved in eosinophil overproduction.

Biologic medications target these substances and processes to temper the inflammatory allergic response and reduce asthma symptoms.

Benefits

Specifically, biologics have shown improvement in the following areas where traditional asthma treatments are ineffective:

  • More effective control of asthma symptoms
  • Decreased need for inhaled and oral (systemic) corticosteroids
  • Fewer asthma exacerbations (serious attacks) and, as a result, fewer emergency medical interventions
  • Greater forced expiratory volume (FEV), a breathing test for lung function
  • Better quality of life

A biologic will not replace other asthma treatments, but be added to them. However, biologics may be effective enough to reduce the need for those other treatments. Biologics have been associated with as much as a 25% decrease in corticosteroid use.

Types of Biologics for Asthma

Five biologics have been approved by the U.S. Food and Drug Administration (FDA) for asthma treatment. They don't all function the same way and each is designed to target a slightly different area of the inflammatory process.

  • Xolair (omalizumab): This was the first biologic approved for use in asthma treatment. It binds with IgE to lower IgE levels and block the production of inflammatory substances. Omalizumab is administered via injection every two to four weeks according to IgE levels and body weight.
  • Nucala (mepolizumab), Cinqair (reslizumab), and Fasenra (benralizumab): These medications target IL-5 and the overproduction of eosinophils. Mepolizumab is injected at a fixed dose of 100 milligrams (mg) every four weeks. Reslizumab is administered intravenously every four weeks at a dose of 3 mg/kg. A 30-mg dose of benralizumab is injected every four weeks for the first three months and then every eight weeks.
  • Dupixent (dupilumab): This drug also targets eosinophil overproduction but does so via the IL-4 and IL-13 pathways. Dupilumab is injected at an initial dose of 400 mg (two 200-mg injections) followed by 200 mg every two weeks, or at an initial dose of 600 mg (two 300-mg injections) followed by 300 mg every two weeks.

The challenge for physicians is assessing which biologic will be most effective for which patients. Age, body weight, and symptom severity are all considerations. Your doctor may use blood tests to help determine proper prescribing/dosage.

Potential Side Effects

While biologics for asthma are generally well tolerated, a number of side effects exist, including:

  • Injection site pain
  • Fatigue
  • Headache
  • Sore throat
  • Anaphylactic (allergic) reaction (with omalizumab)
  • Elevated infection risk (with mepolizumab)

A Word From Verywell

Biologics for severe asthma are still relatively new treatments, but the clinical results have been impressive. Your doctor will be able to answer specific questions about biologics and if they may be an effective treatment for your asthma.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Busse WW. Biological treatments for severe asthma: A major advance in asthma care. Allergol Int. 2019;68(2):158-166. doi:10.1016/j.alit.2019.01.004

  2. American Academy of Allergy, Asthma, and Immunology. Immunoglobulin E (IgE) definition. Updated 2020.

  3. Johnson N, Varughese B, De La Torre MA, Surani SR, Udeani G. A Review of Respiratory Biologic Agents in Severe AsthmaCureus. 2019;11(9):e5690. Published 2019 Sep 18. doi:10.7759/cureus.5690

  4. Edris, A., De Feyter, S., Maes, T. et al. Monoclonal antibodies in type 2 asthma: a systematic review and network meta-analysisRespir Res 20, 179 (2019). https://doi.org/10.1186/s12931-019-1138-3

  5. Rabe KF, Nair P, Brusselle G, et al. Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe AsthmaN Engl J Med. 2018;378(26):2475-2485. doi:10.1056/NEJMoa1804093

  6. Rogliani, P., Calzetta, L., Matera, M.G. et al. Severe asthma and biological therapy: When, which, and for whomPulm Ther. 2019. doi:10.1007/s41030-019-00109-1

  7. American Academy of Allergy, Asthma, and Immunology. Biologics for the treatment of severe asthma. Updated March 22, 2019.

Additional Reading