New treatments for severe asthma

Monoclonal antibodies like Xolair and Mepolizumab are changing the way severe asthma is treated

Scientists are always working on new treatments for severe asthma, many through research programmes supported by Asthma UK. The latest types of medicine used to treat it are monoclonal antibodies. You might sometimes hear them referred to as ‘MABS’ or ‘biologics’. 

Monoclonal antibodies work completely differently to other asthma medicines. If you have severe asthma and your symptoms aren’t helped by other treatments, they might work for you as add-on treatments.

Our Q&A will tell you all you need to know.

What are monoclonal antibodies?

How do these treatments work?

Do these treatments help everyone with severe asthma?

How does your healthcare professional decide if a MAB could help you?

Do monoclonal antibodies replace other asthma medicines?

Are monoclonal antibodies pills or inhalers to use at home?

What are the side effects?

Who can get treatment with Omalizumab (Xolair)?

Who can get treatment with Mepolizumab (Nucala)?

Who can get treatment with Reslizumab (Cinqaero)?

Who can get access to Benralizumab (Fasenra)? 

What monoclonal antibody treatments might be available in the future?

What are monoclonal antibodies? (MABS)

Monoclonal antibodies are targeted biological medicines that can help some people with severe asthma, a kind of asthma that is often not manageable with usual asthma treatments. 

Around 5% of all people with asthma have severe asthma – that’s around 250,000 adults and children in the UK. If the usual severe asthma treatments aren’t working, MABS might be an option for you as an add-on treatment.

How do these treatments work?

Monoclonal antibodies work by blocking the activity of some of the immune system chemicals that trigger inflammation in your airways. This means you may not get your usual asthma symptoms as often, or they may be milder, and you’ll lower your risk of an asthma attack

Do these treatments help everyone with severe asthma?

Monoclonal antibodies are a very promising treatment for around 40% of all people with severe asthma.

  • MABS can help a type of severe asthma known as severe allergic asthma, including eosinophilic asthma.
  • Not all MABs work for everyone with these types of asthma; if you are eligible, your healthcare professional will work with you to find the specific monoclonal antibody most likely to help you.
  • Once you start taking a MAB, you’ll be monitored to see how well it works for you. If it doesn’t work well, it will be stopped, and your healthcare professional will work out alternatives with you. 

How does your healthcare professional decide if a MAB could help you?

If you’ve been diagnosed with severe asthma, you’ve tried all the usual asthma treatments and you’ve taken them exactly as prescribed, but your symptoms haven’t improved, you could be a candidate for monoclonal antibody treatments.

  • Your GP or asthma nurse is likely to send you to a specialist asthma clinic or centre for a consultation.
  • The specialist clinic will carry out tests to see if you would benefit from taking a monoclonal antibody treatment, and which one will target your specific type of asthma. 
  • If one type of monoclonal antibody treatment doesn’t work for you, you may be able to try another. 

Do monoclonal antibodies replace other asthma medicines?

No. They are an 'add-on' to your current treatment. This means:

  • if you’re on a MAB treatment you still need to take your other asthma medicines alongside this new treatment
  • you’ll still need to keep your reliever inhaler with you at all times in case you have an asthma attack. MABS cannot treat an asthma attack and will not prevent all asthma attacks.
  • you may be able to take steroid tablets at a lower dose or less frequently over time as long as you and your healthcare professional find the MAB helps manage your asthma symptoms
  • different people need to take these medicines for different lengths of time – your healthcare professional can tell you how long you’ll need to take it. 

Are monoclonal antibodies pills, or inhalers, to use at home?

Most of these treatments are given as an injection under the skin or as an intravenous infusion. This means:

  • you’ll need to go to hospital, probably every two to four weeks, for treatment – unless you are taking mepolizumab (Nucala) which some people can now take at home
  • you’ll need to make sure you’re available when your treatment’s due – if you miss a dose, you’ll start to lose the protective effect
  • you’ll still need to take your other asthma medicines alongside this treatment and keep your blue reliever inhaler with you in case of emergencies.

What are the side effects?

Like all medicines, monoclonal antibody treatments can have some side effects. And the list of potential side effects can look worrying. But remember, most people won’t experience them. The most common side effect is discomfort at the injection site, which is temporary. 

Who can get treatment with Omalizumab (Xolair)?

Omalizumab injections are available on the NHS throughout the UK for people with a type of severe allergic asthma. 

If you have this type of asthma, your body makes immune system chemicals including antibodies called 'IgE' when you have an allergic reaction. These IgE antibodies play a part in creating the inflammation that causes your asthma symptoms. Omalizumab blocks them.

You will only be offered Omalizumab if:

  • you’ve been diagnosed with a certain severe, allergic asthma type that doesn’t respond to the usual asthma treatments, and
  • you’ve needed continuous or frequent treatment steroid tablets – at least four or more courses in the past year.

Who can get treatment with Mepolizumab (Nucala)?

Mepolizumab injections are available on the NHS throughout the UK for people with a type of asthma called eosinophilic asthma.

If you have this type of asthma, the inflammation is caused by a type of white blood cell called the eosinophil cell. Mepolizumab reduces the level of these cells to control the inflammation.

You will only be offered Mepolizumab if: 

  • you’ve been diagnosed with severe, eosinophilic asthma that doesn’t respond to standard therapies, and
  • 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, or
  • you’ve needed continuous steroid tablets (at least the equivalent of 5mg prednisolone per day) over the last six months.

Who can get treatment with Reslizumab (Cinqaero)?

Reslizumab infusions have recently been approved by NICE for use in England for people with severe eosinophilic asthma.

Reslizumab lowers the number of inflammation-causing cells (eosinophils) and improves symptom control for people with this type of severe asthma. 

You will only be offered Reslizumab if:

  • you’ve been diagnosed with severe, eosinophilic asthma that doesn’t respond to standard therapies, and
  • 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, or
  • you’ve been on high doses of steroid tablets, alongside another preventer medicine, and these haven’t helped you.

Who can get treatment with Benralizumab (Fasenra)?

Benralizumab injections are now available for people with severe asthma throughout the UK. 

You’ll only be offered benralizumab if:

  • you’ve been diagnosed with a certain severe, eosinophilic asthma type that doesn’t respond to standard therapies

And either 

  • your eosinophil blood count has reached 300 or more (or in Scotland, at least 150 at the start of treatment), and
  • you’re taking steroid tablets, or have had four or more asthma attacks in the last 12 months (or both)

Or (does not apply in Scotland)

  • 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.

What treatments might be available in the future?

Asthma UK is working hard to promote the research, development and availability across the UK of new medicines and treatments for all types of asthma.

For example, we want Reslizumab, which is currently only available in England and Wales, to be more widely available across the UK.

Dupilumab is a new monoclonal antibody treatment currently on trial, with results due in 2020.

You can read more about Asthma UK’s research into future treatments, and how we’re working towards finding a cure for severe asthma.

Last updated January 2019

Next review due January 2022