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Everything You Need to Know About Monoclonal Antibodies mAbs for Asthma

Medically reviewed by Marc Meth, MD, FACAAI, FAAAI — By Cathy Lovering on October 19, 2022Monoclonal antibodies 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. Asthma is a chronic condition that causes inflammation and narrowing of the airways. Common symptoms include:regular coughshortness of breathwheezingchest tightness According to the Centers for Disease Control and Prevention (CDC), asthma is more common among members of non-Hispanic Black, non-Hispanic multiple-race, and Puerto Rican communities. Exposure to an allergen often triggers asthma (allergic asthma). Stress, exercise, and particles in the air may also be triggers (nonallergic asthma). Eosinophilic asthma is a severe subtype of asthma in which someone has an excess of eosinophils, a type of white blood cell. Monoclonal antibodies (mAbs) are biologic drugs that work in a targeted manner on inflammation in people with severe asthma. This article will review how they work and which mAbs are currently available.

What are monoclonal antibodies

Your immune system creates antibodies against dangerous invaders. If you have an autoimmune disorder, those antibodies may attack healthy parts of your body. Monoclonal antibodies are manufactured antibodies that are created by scientists in a lab. They target harmful proteins that damage healthy tissue.

How monoclonal antibodies work to treat asthma

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 cascade, as it has many parts. 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. Monoclonal antibodies 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. Currently, six monoclonal antibodies are Food and Drug Administration (FDA)-approved to treat severe asthma. Let’s take a look at them.

Omalizumab Xolair

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 caused by exposure to allergens like dust mites, pollen, and dander. Some of the possible side effects of this medication include:swelling or itching at the injection sitejoint painarm or leg painear painheadachenauseastomach painnosebleedsswelling of the throat or sinusesMedical emergency 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 sorescoughing up bloodshortness of breathfever, rash, muscle aches, and swollen glands 1 to 5 days after injectionpain, numbness, and tingling in hands and feet

Mepolizumab Nucala

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 sitedry or itchy skinheadacheback painjoint painmuscle spasmsdryness in nasal passagesthroat or mouth painMedical emergency The more serious side effects of mepolizumab require medical attention. Call your doctor or visit an emergency department if you experience any of the following:wheezing or breathing problemscoughhivesrashskin that appears flushshortness of breathtightness in the chestfaintingdizzinessdifficulty swallowing

Reslizumab Cinqair

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 include:mouth and throat painmuscle painback painfatiguenauseareactions at the injection siteelevated creatine kinase (enzyme) levelsMedical emergency Reslizumab 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 problemspale or flushed skinshortness of breathfaintingdizzinesslightheadednessconfusionrapid heart rateswelling of the facenauseadifficulty swallowinghivesitching

Benralizumab Fasenra

Benralizumab is another mAb to treat 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 emergency There are some serious side effects of benralizumab that require immediate medical attention. Call your doctor immediately or go to an emergency department if you experience:wheezing or breathing problemshivesrashflushed skinfaintingdizzinessswelling of the face, tongue, or mouth

Dupilumab Dupixent

Dupilumab also treats severe eosinophilic asthma. It is an injection you can take at home, although your doctor may give the initial dose in their office. More common side effects of dupilumab include:infection signs, like sore through, cough, and runny nosepain or redness at the injection sitetoothachelip or mouth soresfacial rednesssleep difficultiesMedical emergency Dupilumab can cause serious side effects. If you experience any of the following, call your doctor or visit your nearest emergency room:new or worsening eye problems, including eye pain and vision changesnew or worsening joint painshortness of breathfeverchest painnumbness or pins and needles in arms or legsswelling of the faceswollen lymph nodestrouble breathing or swallowingchest or throat tightness faintingdizzinessrash, itchiness, or hivesrapid heartbeatnausea, vomiting, or stomach crampsfirm and painful skin lumps

Tezepelumab Tezspire

Tezepelumab is the newest mAb for asthma to receive FDA approval. It works by targeting thymic stromal lymphopoietin (TSLP), which is a component of airway inflammation. 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 in a clinical setting. Some more common side effects of tezepelumab include:pain or swelling at the injection sitejoint painback painsore throatMedical emergency Some side effects of tezepelumab may indicate a medical emergency. Call your doctor immediately or visit the nearest emergency room if you experience any of the following:itchy, red, swollen, or inflamed eyeshivesrashbreathing problems

Side effects of mAbs for asthma

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:headachesore throatfatiguesoreness at the injection site If you are concerned about these side effects, you may want to discuss this with a doctor.

Additional asthma treatments

Basic asthma therapy typically involves quick relief and long-acting bronchodilators. These open the airways in your lungs in the event of asthma symptoms. You usually take them together with long-term control medications, such as inhaled corticosteroids. In addition to mAbs for asthma, these treatments are usually necessary to help you find relief.

Immunotherapy

Allergen immunotherapy exposes you to an allergen that triggers your asthma in a controlled setting. The treatment targets the allergic response itself and not just symptoms. This can help reduce asthma symptoms over time.

Bronchial thermoplasty

Bronchial thermoplasty (BT) uses radio frequencies to remove some smooth muscle tissue from the airways in your lungs. This results in less narrowing of the airways. Doctors usually reserve BT for people with severe asthma for whom mAbs are not available or fail.

Which mAb is best for asthma

A 2019 study compared three different mAbs for asthma and found that they worked equally well. The researchers said that more head-to-head studies are needed to compare the different mAbs. What works best for you will depend on many factors.

Summary

Monoclonal antibodies are a newer treatment for severe asthma. They are made in a lab and mimic the antibodies found in your body. Each mAb targets a specific protein in the inflammatory response. The mAb your doctor recommends may depend on several factors, including:type of asthmayour agehow well other medications work In some cases, a doctor may even prescribe more than one mAb.mAbBinds toAvailable asTreatsFor agesBenralizumab Fasenra Interleukin-5Rαprefilled syringe, autoinjector pensevere eosinophilic asthma12 years and olderDupilumab Dupixent Interleukin-4Rαprefilled syringe, autoinjector pensevere eosinophilic asthma6 years and olderMepolizumab Nucala Interleukin-5prefilled syringe, autoinjector pensevere eosinophilic asthma6 years and olderOmalizumab Xolair IgEprefilled syringesevere allergic asthma6 years and olderReslizumab Cinqair Interleukin-5IV infusionsevere eosinophilic asthma18 years and olderTezepelumab Tezspire TSLP (thymic stromal lymphopoietin)prefilled syringesevere asthma12 years and older Last medically reviewed on October 19, 2022

How we vetted this article

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acaai.org/asthma/asthma-101/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 19, 2022 By Cathy Lovering Edited By A. L. Heywood Medically Reviewed By Marc Meth, MD, FACAAI, FAAAI Copy Edited By Megan McMorris Share this articleMedically reviewed by Marc Meth, MD, FACAAI, FAAAI — By Cathy Lovering on October 19, 2022

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