Table 6

Biologic agents used in the management of asthma

BiologicRoute and frequencyMechanism of actionEffect on asthma symptoms*Effect on attacks and mortality*Safety concerns/common adverse reactions*
OmalizumabSubcutaneous injection every 4 weeksIgG1K antibody that binds to the Fc portion of IgE, resulting in the inability of IgE to bind to the IgE receptor on mast cells.68 This reduces the concentration of free circulating IgE and consequently mast cell degranulation.69Improved asthma symptoms70Reduced asthma attacks70 71Mild injection site reactions, headache, fever, abdominal pain, gastroenteritis and nasopharyngitis72
DupilumabSubcutaneous injection every 2 weeksBinds to alpha component of IL-4 receptor blocking IL-4 and IL-13 stimulation of B-cells73Improved asthma symptoms and quality of life74Reduced asthma attacks75Mild injection site reactions and eosinophilia75
MepolizumabSubcutaneous injection every 4 weeksBinds to IL-5 cytokines resulting in reduced peripheral eosinophilia and reduced airway inflammation76Improved asthma symptoms and quality of life77Reduced asthma attacks77 78Headache, attack of asthma symptoms and bronchitis79 80
ReslizumabIntravenous infusion every 4 weeksBinds to IL-5 cytokines, resulting in reduced peripheral eosinophilia and reduced airway inflammation76Improved asthma symptoms and quality of life81Reduced asthma attacks81Attack of asthma symptoms, nasopharyngitis and upper respiratory tract infections82
BenralizumabSubcutaneous injection every 4 weeks for the first three doses and then every 8 weeksBinds to alpha component of IL-5 receptor, resulting in reduced eosinophil activation from IL-583Improved asthma symptoms and quality of life84Reduced asthma attacks84Headache, sinusitis, nasopharyngitis and fever84

  • *Detailed appraisal of the evidence base for their use is provided in the individual management guidelines and has been recently reviewed.17

  • IL, interleukin.