SIX BIOLOGICS ARE NOW APPROVED TO TREAT ASTHMA
April 18, 2022 - It's no secret that biologics have transformed healthcare, with once difficult to treat diseases like rheumatoid arthritis, inflammatory bowel disease, and psoriasis now being quite manageable in many. Biologics that target inflammatory mediators (e.g. TNF inhibitors, IL inhibitors) are also very safe and well-tolerated, making them useful in a wide range of patients. Asthma, a condition driven by inflammatory pathways in the lungs, is a logical candidate for biologic therapy, and six biologics are now approved to treat it. A review of these drugs is provided below.
- IgE inhibitor - the first asthma biologic available was Xolair (omalizumab), an IgE inhibitor FDA-approved in 2003. It was intended for use in patients with positive allergen skin testing and carried the nuance that dose adjustments were based on serum IgE levels.
- IL-5 inhibitors - from 2015 to 2017, three interleukin-5 (IL-5) inhibitors (Fasenra, Nucala, Cinqair) came to market, and all were approved to treat eosinophilic asthma, which was loosely defined as asthma with blood eosinophil counts greater than 150 to 400 cells/µl, depending on the study.
- IL-4/IL-13 inhibitor - in 2018, the IL-4/IL-13 inhibitor Dupixent (dupilumab), which was originally approved for atopic dermatitis, received an indication to treat eosinophilic asthma and oral corticosteroid-dependent asthma.
- Thymic stromal lymphopoietin (TSLP) blocker - in 2021, Tezspire (tezepelumab), a drug that blocks a cytokine called thymic stromal lymphopoietin (TSLP), was approved to treat severe asthma.
Biologics continue to reshape many conditions, and as their use has expanded, they have proven to be both effective and safe therapies. Their main drawback is cost, but many manufacturers have generous patient assistance programs, and biosimilars are continually coming to market. See the Straight Healthcare asthma biologic page for a review of the therapies mentioned above.