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People with eosinophilic asthma or severe persistent allergic asthma are now being offered a newer type of treatment alongside their usual asthma medicines. These are known as Monoclonal Antibodies, also referred to as mAbs, or biologics.
Biologic therapies are a new type of medicine which works in a different way to traditional asthma treatments. They can improve symptoms and reduce asthma attacks in people with severe asthma by helping to stop the body processes that cause lung inflammation. If the biologic works well it can also reduce the need for steroids.
Biologic treatments are only offered by Specialist Asthma clinics. Your GP or Asthma nurse will need to refer you to a consultant at a specialist clinic for tests to see if you would benefit from a biologic therapy. At the clinic you will be able to discuss the right biologic for you and how often you can take it.
If you start a trial on a biologic, it is really important that you continue to take all your prescribed medicines. Your usual asthma medication will be reviewed regularly and you may be able to stop any that you don’t need, but that can take some time.
There are currently five biologics available on the NHS for treating severe asthma:
Xolair (Omalizumab) and Dupixent (Dupilumab) are recommended for people with severe allergic asthma. They target a chemical in your blood stream called IgE which is involved in the allergic response to an asthma trigger.
Nucala (Mepolizumab), Cinqaero (Reslizumab) and Fasenra (Benralizumab) are for people who have severe eosinophilic asthma. This is asthma driven by high levels of a type of white blood cell called eosinophils. If you have high levels of eosinophils in your blood it can cause the lung to become inflamed, leading to asthma symptoms and asthma attacks.
Below you’ll find more details on the biologics currently available.
Xolair is offered to people with severe allergic asthma. It works by reducing the amount of a chemical called IgE in the body. IgE is produced when a person has an allergic reaction, but some people produce too much and this can cause inflammation in the lungs. Xolair stops IgE being made and can lower the risk of asthma attacks and relieve asthma symptoms.
It is given as an injection every 2 to 4 weeks depending on your weight and the levels of IgE in your blood.
You will only be offered Xolair if:
- you’ve been diagnosed with severe persistent allergic asthma that doesn’t respond to the usual asthma treatments
- you’ve been on a continuous steroid treatment or had at least four courses of steroids in the past 12 months
Dupilumab is recommended for people with severe asthma associated with allergy.
Clinical trials have found Dupilumab to cut the risk of an asthma attack by half.
At the moment, dupilumab is available to people in Scotland, but it has now been approved for use across the whole UK, and people in England, Wales and Northern Ireland should be able to access it early in 2022.
Dupilumab is given as an injection every two weeks and taken alongside your usual asthma treatments.
You will only be offered Dupilumab if you have had two or more courses of oral steroid tablets, or stayed overnight in hospital, in the last year.
You’ll need to meet the following criteria:
- You are taking all your medicines as instructed by your doctor, and
- You have a blood eosinophil count of 150 cells per microlitre or more and fractional exhaled nitric oxide (FeNO) of 25 parts per billion or more, and
- You have had four or more asthma attacks in the previous 12 months, and
- You are not eligible for other biologics or your asthma has not responded adequately to other biologic treatments.
Nucala is given to people with severe eosinophilic asthma. It works by reducing the number of eosinophils in the body and lowers the inflammation that can cause asthma symptoms and attacks.
Nucala is given as an injection (usually into the upper arm) every 4 weeks.
You will only be offered Nucala if:
- you’ve been diagnosed with severe eosinophilic asthma that doesn’t respond to standard therapies
- your eosinophil blood count has reached 300 cells or more at least once in the past twelve months (in Scotland, at least 150 at the start of treatment) and you’ve had four or more asthma attacks needing steroid tablets in the past 12 months
- you’ve needed continuous steroid tablets (at least the equivalent of 5mg prednisolone per day) over the last six months
Cinqaero reduces the number of eosinophils going round the body. This lowers inflammation during an allergic reaction and reduces the risk of asthma symptoms and asthma attacks. Cinqaero is given slowly through a vein every 4 weeks and you can only receive it in hospital.
You will only be offered Cinqaero if:
- you’ve been diagnosed with severe, eosinophilic asthma that doesn’t respond to standard therapies
- your eosinophil blood count has reached 400 or more, and you’ve had three or more asthma attacks needing steroid tablets in the past 12 months.
- you’ve been on high doses of steroid tablets, alongside another preventer medicine, and these haven’t helped you.
Fasenra reduces eosinophils levels in the body. It can reduce the inflammation that leads to asthma symptoms and asthma attacks. Fasenra is given as an injection every 4 weeks for the first 3 doses and then every 8 weeks.
You may be offered Fasenra if:
- you’ve been diagnosed with severe eosinophilic asthma and it hasn’t responded to any standard treatments for asthma.
- your eosinophil blood count has reached 300, and you have had four or more asthma attacks in the last 12 months which have needed steroid treatments or you have been taking steroid tablets daily for the last six months.
- your eosinophil blood count has reached 400 or more and you’ve had three or more asthma attacks needing steroid tablets or injections in the past 12 months.
- Once you start taking a biologic you’ll be monitored to see how well it works for you. This is usually for 12 months.
- You will still need to take your usual medicines, including your inhalers, even if you are on a biologic therapy.
- Most biologics are given at a specialist asthma clinic or a hospital so you will have to travel regularly for your treatment. If you miss a dose the treatment will be less effective.
- Biologics are generally very safe but can rarely cause side effects such as minor irritation at the injection site, headaches, tiredness and cold like symptoms.
- If your asthma does not improve after receiving 4-12 months of a biologic treatment, or you have been unable to reduce your daily steroid dose, you and your asthma will be re-assessed and you may be offered another biologic treatment.
- If your asthma does improve with biologic treatment, your asthma specialist will discuss with you about continuing it longer term.
- Usually you must have been following your standard treatment plans, and taking all your prescribed medicines properly, to be offered biologic therapy.
Last updated March 2020
Next review due January 2022