Monoclonal antibodies (mAbs) are medications that target specific proteins to help reduce inflammation in people with severe asthma. The FDA has approved six mAbs for asthma treatment so far.
Monoclonal antibodies (mAbs) are a relatively new treatment for asthma. They provide options for people who live with severe asthma when other medications don’t provide enough help.
Your immune system creates antibodies to help protect you against dangerous invaders. If you have an autoimmune disorder, those antibodies may attack healthy parts of your body.
In asthma, exposure to an allergen or trigger may cause inflammation and narrowing of the airways.
MAbs are
This article will review how they work and which mAbs are currently available.
When your immune system responds to a perceived threat, such as an allergen or virus, the response is called inflammation. Scientists sometimes call this a
The cascade includes some factors that increase inflammation and some that decrease it. In healthy people, those factors are in balance. If you have an immune-mediated disorder, they are often out of balance.
Among those factors are different proteins made by white blood cells. MAbs each target a specific protein, aiming to keep the factors in balance. If the drug targets the right part of the cascade, it should reduce symptoms in people with severe asthma.
The Food and Drug Administration (FDA) has so far approved six mAbs to treat severe asthma. Let’s take a look at them.
Omalizumab binds to Immunoglobulin E (IgE), an antibody you produce that is involved in allergic reactions. This mAb is for people with severe allergic asthma
Some of the possible side effects of this medication include:
- swelling or itching at the injection site
- joint pain
- arm or leg pain
- ear pain
- headache
- nausea
- stomach pain
- nosebleeds
- swelling of the throat or sinuses
A doctor will administer 75 to 375 milligrams (mg) via injection every 2 to 4 weeks. The dosage will depend on several factors, such as your body weight and serum total IgE level (IU/mL).
Medical emergencyIn rare cases, Omalizumab can cause a life threatening allergic reaction, even if you have taken it before. This reaction can happen immediately or up to 4 days after receiving a dose.
Seek medical attention immediately if you experience any of the following:
- skin sores
- coughing up blood
- shortness of breath
- fever, rash, muscle aches, and swollen glands 1 to 5 days after injection
- pain, numbness, and tingling in hands and feet
Doctors prescribe mepolizumab to treat eosinophilic asthma and another condition called eosinophilic granulomatosis with polyangiitis (EGPA). People with EGPA experience eosinophilic asthma, a high number of white blood cells, and swelling of the blood vessels.
Mepolizumab can cause mild or more serious side effects. Some of the more common side effects include:
- pain, itching, or burning at the injection site
- dry or itchy skin
- headache
- fatigue
- back pain
- flu
- eczema
- abdominal pain
- urinary tract infection
- muscle spasms
- dryness in nasal passages
- throat or mouth pain
Mepolizumab is administered every 4 weeks via injection. The dose will depend on your age:
- 6 to 11 years old: 40 mg
- 12 years and older: 100 mg
Medical emergencyIn rare cases, mepolizumab may cause side effects that require medical attention. Call a doctor or visit an emergency department if you experience any of the following:
- wheezing or breathing problems
- cough
- hives
- rash
- skin that appears flush
- shortness of breath
- tightness in the chest
- fainting
- dizziness
- difficulty swallowing
Reslizumab is for people with severe eosinophilic asthma. It is different from other mAbs for asthma because you receive it by intravenous (IV) injection from a healthcare professional once every 4 weeks. Each dose usually takes about 20 to 50 minutes.
There are mild and more severe possible side effects of reslizumab. Some of the more common side effects
- mouth and throat pain
- muscle pain
- back pain
- fatigue
- nausea
- reactions at the injection site
- elevated creatine kinase (enzyme) levels
Medical emergencyReslizumab can cause a severe life threatening reaction. This reaction might happen immediately after the IV infusion or shortly after it has finished.
Seek medical attention immediately if you experience any of the following:
- wheezing or breathing problems
- pale or flushed skin
- shortness of breath
- fainting
- dizziness
- lightheadedness
- confusion
- rapid heart rate
- swelling of the face
- nausea
- difficulty swallowing
- hives
- itching
Benralizumab is another mAb used to treat severe asthma and eosinophilic asthma. You’ll also typically receive this in a healthcare setting, but it is an injection and not an IV infusion.
Benralizumab can cause mild side effects like headache or sore throat.
Medical emergencyThere are some serious possible side effects of benralizumab that may require immediate medical attention. Call a doctor immediately or go to an emergency department if you experience:
- wheezing or breathing problems
- hives
- rash
- flushed skin
- fainting
- dizziness
- swelling of the face, tongue, or mouth
Dupilumab also treats severe eosinophilic asthma. It is an injection that can be taken at home, although a doctor may give the initial dose in their office.
More common side effects of dupilumab may include:
- infection signs, like sore through, cough, and runny nose
- pain or skin discoloration at the injection site
- toothache
- lip or mouth sores
- facial flushing
- sleep difficulties
Medical emergencyDupilumab can cause serious side effects. If you experience any of the following, call a doctor or visit your nearest emergency room:
- new or worsening eye problems, including eye pain and vision changes
- new or worsening joint pain
- shortness of breath
- fever
- chest pain
- numbness or pins and needles in arms or legs
- swelling of the face
- swollen lymph nodes
- trouble breathing or swallowing
- chest or throat tightness
- fainting
- dizziness
- rash, itchiness, or hives
- rapid heartbeat
- nausea, vomiting, or stomach cramps
- firm and painful skin lumps
Tezepelumab is the newest mAb for asthma to receive
Tezepelumab is for use with all forms of severe asthma. It is the first biologic not limited to a subtype of asthma.
You usually receive a dose once every 4 weeks. A healthcare professional administers it via injection in a clinical setting.
Some more common side effects of tezepelumab may include:
- pain or swelling at the injection site
- joint pain
- back pain
- sore throat
Medical emergencySome possible side effects of tezepelumab may indicate a medical emergency. Call a doctor immediately or visit the nearest emergency room if you experience any of the following:
- itchy, red, swollen, or inflamed eyes
- hives
- rash
- breathing problems
Studies show that mAbs for asthma are typically safe. While some have a risk of more serious side effects, these appear to be rare.
All treatments have some common side effects, including:
- headache
- sore throat
- fatigue
- soreness at the injection site
If you are concerned about these side effects, you may want to discuss this with a doctor.
Which mAb is best for asthma?
A
What works best for you will depend on many factors.
The mAb your doctor recommends may depend on several factors, such as the type of asthma, your age, and how well other medications work.
In some cases, a doctor may even prescribe
The table below highlights the key differences between mAbs for severe asthma:
| mAb | Binds to | Available as | Treats | For ages |
|---|---|---|---|---|
| Benralizumab (Fasenra) | Interleukin-5Rα | prefilled syringe, autoinjector pen | severe eosinophilic asthma | 12 years and older |
| Dupilumab (Dupixent) | Interleukin-4Rα | prefilled syringe, autoinjector pen | severe eosinophilic asthma | 6 years and older |
| Mepolizumab (Nucala) | Interleukin-5 | prefilled syringe, autoinjector pen | severe eosinophilic asthma | 6 years and older |
| Omalizumab (Xolair) | IgE | prefilled syringe | severe allergic asthma | 6 years and older |
| Reslizumab (Cinqair) | Interleukin-5 | IV infusion | severe eosinophilic asthma | 18 years and older |
| Tezepelumab (Tezspire) | TSLP (thymic stromal lymphopoietin) | prefilled syringe | severe asthma | 12 years and older |
Monoclonal antibodies (mAbs) are a type of treatment for severe asthma that are made in a lab to mimic the antibodies found in your body. Each mAb targets a specific protein in the inflammatory response.
There are currently six FDA-approved mAbs for severe asthma.
A healthcare professional could help develop the best treatment plan for you, which may include mAbs, inhalers, and immunotherapy, among other treatments.