Biologic therapies for asthma, atopic dermatitis, and chronic idiopathic urticaria

In the last few years, a number of biologics have been approved by the FDA for the treatment of severe asthma and moderate or severe atopic dermatitis.

• Mepolizumab (Nucala) is an anti-IL-5 agent approved for treatment of severe asthma in those 12 years of age and above. It is administered subcutaneously every 4 weeks.
• Reslizumab (Cinqair) is another anti-IL-5 agent approved for the treatment of severe asthma in patients 18 years and above. It is administered intravenously every 4 weeks.
• Benralizumab (Fasenra) is an anti-IL-5-receptor alpha agent approved for the treatment of severe asthma in patients 12 years and above. It is administered subcutaneously every 4 weeks for 3 doses, then every 8 weeks.
• Dupilumab (Dupixent) is an anti-IL-4-receptor alpha agent approved for the treatment of moderate or severe atopic dermatitis in patients 18 years and above, and very recently, also approved for the treatment of severe asthma in patients 12 years and above. It is administered subcutaneously every 2 weeks.
• Omalizumab (Xolair) has been used for years in the treatment of severe asthmatics with elevated IgE and sensitivity to perennial allergens. In 2014, the FDA also approved it for the treatment of difficult-to-control chronic idiopathic urticaria.

While our general approach is to consider all reasonable options (with safety, efficacy, and cost in mind) in the treatment of our patients with asthma, atopic dermatitis, or chronic urticaria, we are familiar with the new biologics and can help in the evaluation and selection of patients who might benefit from them.