Biologic Therapy for Severe Asthma

What is biologic therapy for asthma?

Biologic therapy for asthma is a newer treatment for moderate to severe asthma. Many people can manage asthma with inhalers. However, some people with moderate to severe asthma have frequent symptoms or flare-ups despite proper use of inhaled therapy. Biologic therapy works by targeting different antibodies, cells or molecules that cause asthma. Biologics may decrease flare-ups, improve quality of life and some can even improve lung function.

Healthcare providers administer biologics either as a shot (subcutaneous injection) or intravenous (IV) infusion. During an IV infusion, a healthcare provider will use a needle to deliver the medication directly into a vein, usually in your arm.

Biologics aren’t a standalone medication. You should take them along with other types of asthma treatments, including:

• Allergy medications. These may include corticosteroids, antihistamines, and antileukotriene medications (for example, montelukast).
• Allergy shots (immunotherapy). Healthcare providers administer allergy shots over a long time — sometimes years — to help reduce or prevent allergy symptoms.
• Asthma inhalers. There are different types of inhalers that you may use in conjunction with biologic therapy to manage moderate to severe asthma.

Who qualifies for biologics for asthma?

A healthcare provider may recommend biologic therapy to treat asthma if:

• You can’t manage your symptoms despite using your asthma medications properly.
• Your blood tests show that you’ll benefit from biologic therapy, including elevated eosinophils (a form of white blood cell that affects inflammation in your lungs) or elevated allergy (immunoglobulin E or IgE) levels.
• Your asthma symptoms persist despite knowing your asthma triggers and regularly avoiding or managing them.
• You have symptoms that wake you up in the middle of the night.
• You use a rescue inhaler more than twice a week.
• You use corticosteroids more than twice a year to help reduce inflammation and swelling in your airways during flare-ups.
• You go to an emergency room (ER) more than twice a year to help manage your asthma symptoms.
• You need a hospital stay due to asthma.

What are the types of biologic therapy drugs for treating asthma?

The following biologic therapy drugs for asthma that have U.S. Food and Drug Administration (FDA) approval include:

Omalizumab

Omalizumab (Xolair^®) helps treat moderate to severe asthma and allergies by blocking the antibody that causes an allergic asthma response. The most common year-round allergens that it treats include:

• Dust mites.
• Pets.
• Cockroaches.
• Molds.

Healthcare providers give Xolair as shots. You may get one or two shots every two or four weeks, depending on your allergy level and weight. You initially receive Xolair shots in an office under medical observation. But some people may eventually be able to get injections at home.

The most common Xolair side effects include:

• Muscle pain.
• Joint pain.
• Feeling very tired (fatigue).
• Pain or swelling around the injection site.

A severe allergic reaction (anaphylaxis) may also occur. There’s also past concern for malignancy (cancer) with omalizumab use.

Mepolizumab

Mepolizumab (Nucala^®) helps treat eosinophilic asthma by blocking certain substances in the blood (IL5) that act on eosinophils. You receive a shot once every four weeks, which you can do at home.

Common Nucala side effects include:

• Headaches.
• Pain or swelling around the injection site.
• Back pain.
• Weakness.
• Fatigue.

Reslizumab

Reslizumab (Cinqair^®) also helps treat eosinophilic asthma by blocking IL5 in your blood. Cinqair is an IV infusion that you receive every four weeks. The process takes less than an hour. But it also requires initial monitoring in a provider’s office.

Common Cinqair side effects include:

• Sore throat.
• Muscle aches.

Benralizumab

Benralizumab (Fasenra^®) is a shot that helps treat eosinophilic asthma by reducing the number of eosinophils in your blood. You’ll receive the first three doses once every four weeks. You’ll then receive a dose once every eight weeks.

Common Fasenra side effects include:

• Headache.
• Sore throat.

Dupilumab

Dupilumab (Dupixent^®) helps treat eosinophilic asthma by blocking other components in your body that cause inflammation. A provider will give you a shot of Dupixent once every two weeks.

Common Dupixent side effects include:

• Sore throat.
• Pain or swelling around the injection site.
• High white blood cell count.

Tezepelumab

Tezepelumab (Tezspire^®) is the newest biologic for treating asthma. The FDA approved it for use in 2021. It helps treat moderate to severe asthma by reducing inflammation. A provider will give you a shot once every four weeks.

Common Tezspire side effects include:

• Sore throat.
• Back pain.
• Joint pain.

How long will I need this treatment?

Healthcare providers don’t currently have set recommendations for how long you should take a biologic for asthma. It can take at least four months to determine if it helps relieve your asthma symptoms.

What is the best biologic for asthma?

There are no studies that compare biologics. Healthcare providers will take various factors into account to determine what is the best biologic for you. These factors include your breathing tests, blood work and your type of asthma.

Will I still need to take my inhalers?

Yes, it’s very important that you continue to use your inhaler and any other asthma medications. A healthcare provider will tell you if you can decrease the dose of any of your other inhalers over time if your asthma is well managed.

What are the potential benefits of this treatment?

The primary benefits of biologic therapy for asthma are that they reduce inflammation in your airways and improve your asthma symptoms.

Other biologic therapy benefits may include:

• Being able to take part in physical activities.
• Fewer trips to the ER to manage your asthma symptoms.
• Less need or lower dosages of allergy medications or immunotherapy.
• Better sleep.
• Not missing as much school or work.

How safe are biologics for asthma?

In general, biologics for asthma are safe. But like all medications, biologics do have potential risks.

What are the disadvantages of biologics for asthma?

Potential biologics risks or side effects include:

• Severe allergic reactions. In rare cases, biologics may cause severe allergic reactions in some people, including hives, skin rash, itching and, in severe cases, anaphylaxis. Healthcare providers will watch you for up to two hours after giving you a biologic to make sure you don’t have a reaction to the medication.
• Greater risk of parasitic infections. Biologics that reduce the number of eosinophils in your blood increase your risk of parasitic infections. Eosinophils help your immune system fight off parasites, especially parasitic worms (helminths).

You may also have a higher risk of worsening asthma symptoms if you stop biologic therapy.

How long will it take for me to feel better?

It depends. Your body is unique, and how it responds to biologics may be different from others. Some people may notice their symptoms start to improve within a week or two. For others, it may take as long as four to six months. Talk to a healthcare provider. They can give you a better idea of when you can expect your symptoms to improve.

When should I call my healthcare provider?

Talk to a healthcare provider if you:

• Don’t see an improvement in your asthma symptoms, or they get worse after several months of biologic therapy.
• Start to develop allergy symptoms.
• Need to reschedule your appointment.
• Have any questions or concerns.

Where can I get biologic treatments for asthma?

An asthma specialist will decide if you’d benefit from biologics according to your symptoms, the medications you’re already taking and blood test results. You’ll receive biologic therapy at an infusion center or a specialist’s office. An infusion center is a healthcare facility in which providers administer shots or IV infusions.

Will my insurance cover biologic therapy for asthma?

Talk to a healthcare provider. A provider can communicate with your insurance company to make sure your insurance approves the treatment. Many pharmaceutical companies also have programs that help people afford treatments.

A note from Cleveland Clinic

Biological therapy for asthma is a relatively new, effective treatment for moderate to severe asthma. It doesn’t just treat your asthma symptoms, but helps to decrease inflammation in your airways. It may take up to several months to notice an improvement in your symptoms. Talk to a healthcare provider. They can determine whether biologics are a good treatment for you.