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 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 see them referred to as ‘MABS’. 

One example is Xolair (omalizumab), which is a type of monoclonal antibody that has been available for a while. Two monoclonal antibodies which are more recent are Mepolizumab and Reslizumab. 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?

Monoclonal antibodies are targeted medicines that can help some people with severe asthma. They work by blocking the activity of some of the immune system chemicals that trigger inflammation in your airways. This means that your airways don’t become so inflamed, so 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. 

What monoclonal antibodies are available at the moment?

Xolair (omalizumab) and mepolizumab (also known as Nucala) are both now available on the NHS throughout the UK. Reslizumab (also known as Cinqaero) has recently been approved by NICE for use in England.

Xolair

Xolair is a targeted treatment for 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. Xolair is an add on therapy to help people with severe allergic asthma.

Mepolizumab

Mepolizumab (also known as Nucala) targets a type of asthma called eosinophilic asthma, where inflammation is caused by a specific type of white blood cell (the eosinophil cell). The treatment controls the level of cells causing the inflammation. People with eosinophilic asthma don't generally have allergies or react to allergic asthma triggers, so this is an effective, targeted treatment for this specific type of non-allergic asthma.

Reslizumab

Reslizumab (also known as Cinqaero) is another treatment targeting severe eosinophilic asthma, lowering the number of inflammatory causing cells and improving symptom control for people with this type of severe asthma. 

What monoclonal antibody treatments might be available in the future?

The National Institute for Health and Care Excellence (NICE) is considering whether reslizumab should be routinely available on the NHS not just in England but across the whole of the UK. 

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 all people with severe asthma who would benefit from them.

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. 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 asthma. But that doesn’t mean they will work for everyone. These new treatments need you to meet a prescribed set of criteria before you are offered them. “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, and which one will target your specific type of asthma. 

How are monoclonal antibody treatments given?

Xolair and Mepolizumab are given as an injection under the skin. Reslizumab (Cinqaero), is 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 October 2017

Next review due December 2019