Biologics are changing how we treat asthma, atopic dermatitis, nasal polyps, and urticaria.
Until now, as a physician treating asthma we have sometimes been faced with no option other than oral steroids and multiple inhalers to provide just a little bit of help. With the advent of biologics it is revolutionizing the care and hope we as allergists can provide to patients.
Biologics for Eosinophilic Asthma
Eosinophilic asthma is a term that describes asthma that is worsened by high numbers of eosinophils. Eosinophils are part of the white blood cell family. They are full of many chemicals called mediators and when the eosinophils rupture they create havoc by releasing these mediators. Mucus production, bronchial constriction, increase in production of eosinophils within the bone marrow and recruitment of more eosinophils all occur once the eosinophils rupture. By reducing the number of eosinophils in the lungs you can achieve a high level of control, frequently better than what an inhaler can provide.
- Nucala is a subcutaneous injection given once a month. Eosinophils need to be at least 150 cells/ul. It is indicated for severe asthma. It is now approved to be given at home without the need of a medical professional to administer.
- Cinqair is given by intravenous route, once a month. Eosinophils need to be at least 400 cells/ul. It is indicated for severe asthma. It is the only IL-5 blocker that is dosed by weight, so a heavier person will receive more Cinqair.
- Fasenra is a subcutaneous injection given once a month for 3 months, and then every other month. Eosinophils need to be 300 cells/ul. It is indicated for severe asthma. It is the only IL-5 blocker that creates apoptosis, (destruction of eosinophils throughout the body).
Each of these IL-5 antagonist are very effective, but it is Interesting that some individuals respond differently to each one. Due to this, you may start on one and then end up on a different one because it works better for you. To determine if you would benefit from using one of these biologics you need to have severe asthma, and elevated level eosinophils, (from 150- 600 cells/ul). A simple CBC and differential will give you your eosinophil level. Work with your physician to run these tests and establish whether you’d be a candidate for these biologics.
Other Biologics used for Moderate to Severe Asthma
- Dupixent (Dupilimab) is a biologic approved for moderate asthma, atopic dermatitis, and nasal polyposis. It is available for those who are twelve years of age and over. Having an elevated eosinophil level can give you a clue that it will provide a bigger benefit for asthma, and sometimes insurance carriers require eosinophils to be in the 300 cells/ul range. It is a subcutaneous injection every 2 weeks that is given at home, without the need to have a medical person with you. This biologic blocks interleukin 4 and 13, (IL-4, IL-13).
- Xolair (Omalizumab) is approved for moderate to severe asthma in the allergic patient and Idiopathic Urticaria. Hives that have persisted for more than six weeks. It is a subcutaneous injection and depending on the age and weight of the individual one or two injections every two weeks or monthly for asthma. For urticaria (hives) one or two injections are given monthly. Blood work is needed to determine the level of immunoglobulin E for asthma, IgE level should be within 30-700 IgE iu/ml. No IgE level is required for use in urticaria. Immunoglobulin E is related to allergy, the higher the immunoglobulin E the more allergic you will be. Xolair binds to the IgE making it inactive.
Insurance Approval for Asthma Biologics
If you suffer with severe asthma and have failed on multiple inhalers, your spirometries are low, and your eosinophils are at the right level your physician should be able to obtain coverage for the biologic. If any of these parameters are not met many insurance carriers will do a peer-to-peer with your physician and at that time they may offer a trial of three months to six months with the biologic to see if it provides a benefit.
Schedule an Appointment
If you’d like to learn more about Biologics or other treatment options for your Asthma, please contact us to schedule an appointment today. Our office is conveniently located right off 435 Highway in Overland Park, KS.
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