1 in 20 people with asthma have severe asthma

Xolair and new treatments for severe asthma

Xolair and other medicines are changing the way severe asthma is treated

Scientists are always working on new treatments for severe asthma - many in research that's supported by Asthma UK. The latest types of medicine used to treat it are monoclonal antibodies. You might sometimes see them referred to as ‘mabs’. 

One example you might have heard of is Xolair (omalizumab), which is a type of monoclonal antibody that has been available for a while. But some others are in the pipeline and might become new treatments for severe asthma in the next few years. 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.

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

What are monoclonal antibodies?

They’re medicines that can help some people with severe allergic asthma. If you have this type of asthma, it means that when you come into contact with something that you’re allergic to (an allergen), your body makes immune system chemicals called antibodies, including antibodies called 'IgE'. These substances are part of the process which triggers the inflammation that causes your asthma symptoms.

Monoclonal antibodies work by blocking the activity of some of the immune system chemicals that trigger inflammation in your airways. This means that when you come into contact with an allergen, your airways don’t become so inflamed, and you may not get your usual asthma symptoms as often, or they may be milder.  

What monoclonal antibodies are available at the moment?

Xolair (omalizumab) and mepolizumab (also known as Nucala) are both available on the NHS throughout the UK. 

What monoclonal antibody treatments might be available in the future?

The National Institute for Health and Care Excellence (NICE) is considering whether reslizumab (also known as Cinqaero) should be routinely available on the NHS in England. A final decision on this has yet to be made.

Asthma UK is responding to these NICE guidelines and attending future committee meetings to help make the case that these treatments should be made available to people with severe asthma.

Other UK nations have their own processes for deciding on new treatments. Wales and Northern Ireland are yet to decide on whether to make Cinqaero available. Other treatments in this category are still being trialled and may also be available in the future. 

Do monoclonal antibody treatments replace other asthma medicines?

No. Xolair, Nucala and other monoclonal antibody treatments don’t take the place of your inhalers or any other treatments you’re taking for your asthma. They are an 'add-on' to your current treatment. But they might help manage your asthma symptoms so that you may be able to take steroid tablets at a lower dose or less frequently over time.

It’s important to remember that monoclonal antibody treatments are not a cure for severe asthma and cannot treat an asthma attack. You’ll still need to keep taking your other asthma medicines, and you should make sure you keep your reliever inhaler with you at all times in case you have an asthma attack.

Do these treatments help everyone with severe asthma?

They are a very promising treatment for some people with severe allergic asthma. But that doesn’t mean they will work for everyone. If your asthma isn’t triggered by an allergen, but instead is triggered by cold weather, for example, monoclonal antibodies won’t help you. “Your specialist will carry out a series of checks and tests to see whether you may benefit,” says Dr Andrew Whittamore, Asthma UK’s in-house GP.

How does your healthcare professional decide whether you would benefit from this sort of medicine?

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, your GP or asthma nurse is likely to send you to a specialist asthma clinic or centre for a consultation. They will carry out a series of tests to see whether you might benefit from taking a monoclonal antibody treatment. 

How are monoclonal antibody treatments given?

Xolair and Nucala are given as an injection under the skin. Cinqaero, if approved, would be given via an infusion (drip) into a vein. At the moment, if you are prescribed this type of treatment, you’ll need to go to hospital, probably every two to four weeks, to have your injection or infusion. That will mean making sure you’re available when your treatment's due. If you miss a dose, you will start to lose the protective effect. 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. 

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. 

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 December 2016

Next review due December 2019