lynnawiensmd 6:50 am on September 1, 2020  

New Biologicals are unknown

I discuss the use of biologicals on a daily basis to #asthma patients that don’t want to use a daily inhaler (especially steroid inhalers). What’s my first response but to hear “I didn’t know that!” Patients absolutely love taking a biological shot every 2-8 weeks for their asthma with the kind of results you get and most of the time very quickly. Since there are four main biologicals that I use for respiratory conditions, I’ll include a YouTube video with a testimonial for each one.
The first video reflects one of our first biologicals to date, that being mepolizumab or (Nucala). As you will hear, before Nucala, we had nothing to use for asthma except the dreaded steroids. Here’s what I like about Nucala:
1. One of the first anti-IL 5 medications to hit the market to reduce asthma exacerbations.
2. Dosing is easy: 100mg every month and it’s not based on weight
What I don’t like about Nucala:
1. Maybe we should be dosing on weight. Several studies that are now looking at Nucala for treatment of EoE find the 300 mg dose works better than the current 100mg.
2. Blocking IL-5 molecule only may not work as well as blocking the receptor itself or blocking other cytokines (IL-4; IL-13)
I will verify that responses you’re about to hear do happen all the time with mepolizumab (Nucala) and it’s been a great addition to our asthma treatment.

What is the magic bullet of medical treatment? How about a biological that treats two or more diseases at one time? Dupilumab (Dupixent) is one such medication and I agree with Dr. Castro’s interpretation of the data on dupilumab–after all, he wrote the study. Here’s what I like about Dupixent:

  1. Blocks 2 cytokines, both IL-4 and IL-13
  2. Treats 3 different diseases: asthma, nasal polyps, and atopic dermatitis.
  3. If you can’t get approved through your insurance, the company has a very good patient assistance program that makes Dupixent affordable for most patients.

Xolair, xolair, xolair. This biological has been around since my days back in Kansas. I have to admit, when Xolair was first released 20 years ago, I thought “who would use this type of medication?” Not only was I wrong, but Xolair has now set the standard for the use of monoclonal treatment of allergic disease, asthma, and urticaria. But I can’t compete with the video on Xolair….enjoy!

The last biological I mention is one that wasn’t the first on the scene, but has made it’s impression with a unique mechanism for getting rid of allergic inflammation: why not block the eosinophil IL-5 receptor directly? What do I like about Fasenra?

  1. Gets rid of eosinophils quickly–you notice within several weeks many times when Fasenra makes you feel better.
  2. After the first 3 doses, you only have to use Fasenra every OTHER month–pretty cool schedule compared to a daily inhaler.
  3. Reduces both exacerbations of asthma AND the need for corticosteroids.