Everything You Need to Know About Monoclonal Antibodies (mAbs) for Asthma

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 site
• joint pain
• arm or leg pain
• ear pain
• headache
• nausea
• stomach pain
• nosebleeds
• swelling of the throat or sinuses

Medical 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 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

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 site
• dry or itchy skin
• headache
• back pain
• joint pain
• muscle spasms
• dryness in nasal passages
• throat or mouth pain

Medical 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 problems
• cough
• hives
• rash
• skin that appears flush
• shortness of breath
• tightness in the chest
• fainting
• dizziness
• difficulty 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 pain
• muscle pain
• back pain
• fatigue
• nausea
• reactions at the injection site
• elevated creatine kinase (enzyme) levels

Medical 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 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 (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 problems
• hives
• rash
• flushed skin
• fainting
• dizziness
• swelling 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 nose
• pain or redness at the injection site
• toothache
• lip or mouth sores
• facial redness
• sleep difficulties

Medical 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 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 (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 site
• joint pain
• back pain
• sore throat

Medical 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 eyes
• hives
• rash
• breathing 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:

• 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.

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.

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 asthma
• your age
• how well other medications work

In some cases, a doctor may even prescribe more than one mAb.