Asthma Biologics: What to Know About Biologic Therapy for Severe Asthma


How do biologics work for asthma?

Biologics target specific immune system cells and proteins, such as eosinophils, interleukin-5, and immunoglobulin E, that contribute to asthma symptoms. By blocking their action, biologics can reduce airway inflammation and improve asthma symptoms. They are administered via injection or infusion and are used for severe asthma.

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What Are Biologics for Severe Asthma?

Biologics is an innovative and highly targeted therapy that has been transforming the lives of many individuals with uncontrolled asthma symptoms. Unlike traditional treatments, biologics are made from living organisms, which are engineered to specifically target certain molecules and pathways responsible for inflammation and constriction within the airways.

Biologics specifically target substances such as cytokines and leukotrienes, which are created when inflammation or allergies occur in the airways, thus reducing the severity of allergic reactions, bronchospasm, mucus production, and airway obstruction associated with asthma.

They work to reduce the frequency and severity of asthma flare-ups, improving the overall quality of life for patients. In contrast to conventional treatments, which often address asthma symptoms, biologics for severe asthma directly tackle the underlying causes, providing a more tailored and personalized approach to managing the condition.

How Do Biologic Injections Work?

For those who suffer from moderate to severe uncontrolled asthma, biologic injections offer a new approach to managing their condition. They mainly work by targeting specific pathways in the body and preventing diseases from progressing. This way of functioning also helps to reduce side effects and provide relief.

Targeting Specific Immune Cells

Biologic injections work by targeting specific immune cells in the body. In the case of asthma, these cells are called eosinophils. Eosinophils are white blood cells that play a crucial role in the immune response in allergic asthma. They produce proteins that contribute to inflammation, airway narrowing, and mucus production.

Biologic injections, such as mepolizumab or benralizumab, bind to these eosinophils, reducing the number of cells and the amount of inflammatory proteins they produce. This process can help reduce asthma symptoms and improve lung function.

Blocking Inflammatory Proteins

Another way biologic injections work is by blocking inflammatory proteins that exacerbate asthma symptoms. Asthma is characterized by airway inflammation, which can make breathing difficult. Biologic injections, such as dupilumab or omalizumab, target and block specific inflammatory proteins, such as interleukin-4, interleukin-13, or IgE antibodies. By blocking these proteins, biologic injections can reduce inflammation and improve lung function, making it easier to breathe.

Mimicking Natural Proteins

Some biologic injections mimic natural proteins in the body, enhancing their effects while reducing the risk of side effects. For example, the biologic injection reslizumab binds to the protein interleukin-5, which is responsible for recruiting and activating eosinophils in the body. Reslizumab mimics natural antibodies that bind to interleukin-5, decreasing the number of eosinophils and inflammatory proteins in the airways. By mimicking natural proteins, biologic injections can be more effective than traditional asthma medications. They're also safer and better tolerated.

Neutralizing Toxins

In some cases, toxins, such as pollen, dust, or pollution, trigger asthma. Biologic injections, such as tezepelumab, target and neutralize these toxins, preventing them from triggering an allergic response. Tezepelumab blocks the activity of a protein called thymic stromal lymphopoietin (TSLP), which is involved in activating immune cells in response to toxins. By neutralizing TSLP, tezepelumab can prevent the release of inflammatory proteins in the airways and reduce asthma symptoms.

Types of Biologic Therapy for Asthma

If you suffer from severe allergic asthma, several biologic therapies can help you manage your symptoms and improve your quality of life. Currently, five main biologic therapies have been approved by the FDA to treat severe asthma. Let's take a closer look at each one.

Omalizumab (Xolair)

Omalizumab is a biologic therapy approved for use in adults and children six years of age and older with moderate-to-severe asthma. This medication works by binding to immunoglobulin E (IgE). IgE is the molecule responsible for triggering allergic reactions in the body.

When it binds to IgE, omalizumab reduces the amount available to trigger an allergic reaction, which can decrease asthma symptoms. Clinical studies have shown that omalizumab can improve lung function, reduce the use of rescue inhalers, and decrease the incidence of asthma attacks.

Mepolizumab (Nucala)

Mepolizumab is a biologic medication approved for use in individuals with severe eosinophilic asthma. Eosinophils are a type of white blood cell involved in allergic inflammation in the airways. This medication works by blocking interleukin-5, a cytokine involved in the production and activation of eosinophils.

By reducing the number of eosinophils in the airways, mepolizumab can decrease inflammation and improve asthma symptoms. Studies have shown that mepolizumab can reduce the frequency of asthma attacks, improve lung function, and reduce the need for oral steroids.

Benralizumab (Fasenra)

Benralizumab is a biologic therapy that targets eosinophil, a type of white blood cell known to contribute to inflammation in asthma. This therapy works as an add-on treatment for people with severe asthma. It binds to eosinophils and triggers a process called antibody-dependent cell-mediated cytotoxicity (ADCC), which leads to the death of eosinophils.

Benralizumab is administered subcutaneously every 4-8 weeks. Studies have shown that this therapy can significantly reduce exacerbations and improve lung function in patients with severe eosinophilic asthma. Common side effects include injection site reactions, fatigue, and headache.

Tezepelumab (Tezspire)

Tezepelumab is a biologic therapy that works by blocking the action of a molecule called thymic stromal lymphopoietin (TSLP), which plays a key role in asthma inflammation. This therapy is administered subcutaneously every 4 weeks.

Clinical trials have shown that tezepelumab can significantly reduce exacerbations and improve lung function in patients with severe asthma, including those with high blood eosinophil counts and fractional exhaled nitric oxide (FeNO) levels. Tezspire has been shown to work for chronic rhinosinusitis nasal polyps, eosinophilic esophagitis (EoE), and chronic spontaneous urticaria.

Dupilumab (Dupixent)

Dupilumab is a biologic therapy that inhibits the action of two key molecules called interleukin-4 (IL-4) and interleukin-13 (IL-13), which are involved in asthma inflammation. This therapy is administered subcutaneously every 2 weeks.

Trials have shown that dupilumab can significantly reduce exacerbations and improve lung function in patients with severe asthma, including those with high FeNO levels. It has also been shown to reduce the need for oral corticosteroids in patients with steroid-dependent asthma.

Who Should Take Biologics?

Biologic therapy is typically recommended if you have moderate-to-severe allergic uncontrolled asthma. Uncontrolled means that it isn't controlled by other treatments, such as inhaled corticosteroids or long-acting beta-agonists (bronchodilator medicine). Generally, biologics are used by:

People with Eosinophilic Asthma

Eosinophilic asthma is a type of asthma that is characterized by high levels of eosinophils, a type of white blood cell that plays a role in inflammation. Eosinophilic asthma is typically diagnosed through a blood or sputum test that measures the number of eosinophils in the body. In this specific type of asthma, biologics can be particularly effective in reducing inflammation and asthma exacerbations.

People with Severe Asthma

For individuals with severe persistent asthma, traditional treatment measures such as inhaled corticosteroids, long-acting beta-agonists, and leukotriene modifiers may not be enough to manage their symptoms. Biologics may be an alternative for reducing inflammation and improving lung function. Biologics are recommended for people with an overall poor asthma control score despite taking high doses of inhaled steroids or those who experience frequent exacerbations.

People with Adverse Effects to Standard Treatment

People with asthma may experience adverse effects to standard treatment measures such as inhaled corticosteroids. Biologics may be a suitable alternative, as they're generally well-tolerated and have fewer side effects than traditional treatments. In some cases, biologic treatment may even reduce oral corticosteroid use, which can lead to fewer adverse effects associated with long-term steroid use.

What Are the Benefits of Biologics?

While many traditional asthma treatments are available, biologics have emerged as an effective and innovative treatment for those struggling with this condition. Let's explore the benefits of biologics for asthma and how they can potentially change the lives of those who have to live with this condition.

Targeted Treatment

Biologics are unique in that they're tailor-made to suit the individual needs of each asthma patient. Unlike traditional asthma treatments that take a "one size fits all" approach, biologics target specific biomarkers that are associated with asthma. This means that patients get personalized treatment based on their individual needs, making it more effective in controlling their asthma.

Fewer Side Effects

Traditional asthma treatments such as steroids can cause various side effects, which can be quite severe, primarily if used over a long period. Biologics, on the other hand, have fewer side effects and are generally better tolerated by patients. Many asthma patients report that they have fewer side effects when they switch to biologics.

Improved Quality of Life

Asthma can have a significant impact on an individual's quality of life. People with this condition often experience frequent coughing, wheezing, and shortness of breath, which can make it difficult to engage in daily activities. Biologics offer a potential way to improve asthma symptoms and help people regain control over their lives. Studies have shown that biologics can reduce asthma symptoms, decrease the need for rescue medication, and improve lung function.

Reduced Healthcare Costs

Asthma can be a very expensive condition to manage. Patients often require frequent visits to healthcare professionals, various medications, and hospitalizations. Biologics can potentially reduce healthcare costs associated with asthma by reducing the frequency of hospitalizations and the need for rescue medication. While biologics are more expensive than traditional asthma treatments, the potential long-term cost savings are significant.

Better Long-Term Outcomes

Asthma is a chronic condition, meaning patients need ongoing treatment to manage their symptoms. Biologics are a promising long-term treatment option for asthma patients because they improve patients' ability to manage their condition effectively. This can prevent disease progression and potentially reduce the risk of asthma-related complications. By targeting specific biomarkers, biologics can also help asthma patients achieve better long-term outcomes than they might with traditional treatments.

Risks and Side Effects of Biologics

While biologics can effectively treat severe asthma, they can also have risks and side effects. Here are some of the potential risks and common side effects of biologics taken for severe asthma:

  • Infections: Biologics can suppress the immune system, making people more susceptible to infections. This can include serious infections such as tuberculosis, bacterial sepsis, and fungal infections.
  • Allergic reactions: Some people may develop an allergic reaction to biologics, which can range from mild to severe. Symptoms may include hives, rash, itching, swelling, difficulty breathing, and anaphylaxis.
  • Autoimmune reactions: Biologics can also trigger autoimmune reactions, where the immune system attacks healthy cells and tissues in the body. This can result in a variety of symptoms, depending on which parts of the body are affected.
  • Cancer: There is a potential risk of developing cancer with some biologics, although this risk is generally considered to be low.
  • Injection site reactions: Some people may experience pain, swelling, and redness at the injection site.
  • Flu-like symptoms: Biologics can sometimes cause flu-like symptoms such as fever, chills, and fatigue.
  • Neurological symptoms: In rare cases, biologics can cause neurological symptoms such as seizures, multiple sclerosis-like symptoms, and optic neuritis.

Alternative Asthma Medications

There are several alternative medications for asthma that you can try. You can use these medications alone or in combination with others, depending on the severity of the asthma symptoms and your specific medical needs. Some of the alternative medications for asthma include:

  • Corticosteroids: Corticosteroid medications such as oral steroids and inhalers are often the first line of treatment for severe asthma and work by reducing inflammation in the airways.
  • Long-acting beta-agonists (LABAs): LABAs work by relaxing the muscles in the airways, making it easier to breathe. They are often used in combination with ICS.
  • Leukotriene modifiers: These medications work by blocking the action of leukotrienes, which are substances that cause inflammation in the airways.
  • Theophylline: This medication works by relaxing the muscles in the airways and reducing inflammation.
  • Short-acting beta-agonists (SABAs): SABAs are used to relieve acute asthma symptoms by quickly relaxing the muscles in the airways.
  • Anticholinergics: These medications work by blocking the action of acetylcholine, which is a neurotransmitter that causes the muscles in the airways to contract.

Work with a doctor to determine the best course of treatment for severe asthma, as the specific medications and dosages will vary. You may also want to make certain lifestyle changes to ease your asthma triggers. For instance, you could avoid allergy triggers such as dust, pollen, dust mites, and pet dander.

When to See a Doctor

If you have severe asthma symptoms that are not well controlled with your current medications or experiencing frequent exacerbations, you should see a doctor. Your doctor can evaluate your symptoms and determine if you are a candidate for biologics or other alternative treatments. Here are some signs that you should see a doctor for severe asthma:

  • If you're experiencing frequent asthma symptoms such as wheezing, coughing, shortness of breath, and chest tightness regularly, you should see a doctor.
  • If you're waking up at night due to asthma symptoms, this may be a sign that your asthma is not well controlled.
  • You should see a doctor if you're experiencing frequent exacerbations or attacks. This may indicate that your asthma is poorly controlled or that you need additional medications or treatments.
  • You should see a doctor if you're using your rescue medication (such as a short-acting beta-agonist) more than twice a week. This may indicate that your asthma is not well controlled.
  • If your asthma symptoms are limiting your ability to carry out daily activities, such as exercise or work, you should see a doctor.
  • If you are having difficulty breathing or are experiencing severe shortness of breath, you should seek immediate medical attention.
  • If you have been hospitalized or visited the emergency room for asthma-related symptoms, you may have severe asthma and should see a doctor to discuss treatment options.

Take Our Allergy Assessment

Allergies are a common trigger for asthma, and it's important to identify and manage them effectively to prevent asthma symptoms. If you suspect you may have allergies contributing to your asthma, Wyndly offers an at-home allergy test that can help you identify potential allergens that may be affecting you. In addition, you can take our allergy assessment survey today to get started on the path toward lifelong relief allergy relief.

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