Table 3.

Biologics for the treatment of Th2-high asthma.

-	Omalizumab (XOLAIR)	Mepolizumab (NUCALA)	Reslizumab (CINQAIR)	Benralizumab (FASENRA)	Dupilumab (DUPIXENT)
FDA approval	Moderate-to-severe persistent asthma in ≥6 years, with a positive skin test or in vitro reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with inhaled corticosteroids	Add-on maintenance treatment for ≥6 years with severe asthma and eosinophilic phenotype	Add-on maintenance treatment for ≥18 years with severe asthma and eosinophilic phenotype	Add-on maintenance treatment for ≥12 years with severe asthma and eosinophilic phenotype	Add-on maintenance treatment for moderate-to-severe asthma ≥12 years with an eosinophilic phenotype or with oral-corticosteroid-dependent asthma
Target	IgE	IL5	IL5	IL5 receptor	IL4 receptor
Route of administration	Subcutaneous	Subcutaneous	Intravenous infusion over 20–50 minutes	Subcutaneous	Subcutaneous
Frequency of administration	Every 2–4 weeks	Every 4 weeks	Every 4 weeks	Every 4 weeks for three doses, then every 8 weeks	Every 2 weeks
Dose	Based on body weight and pretreatment serum IgE	40 mg for 6–11 years; 100 mg for ≥12 years	3 mg/kg body weight	30 mg	Initial dose 400 mg followed by doses of 200 mg Or initial dose 600 mg followed by doses of 300 mg
Benefits	Fewer exacerbations and decreased need for ICS and rescue treatment [77] Improvement in asthma-related quality of life [78] compared with placebo	Reduced rate of exacerbations and reduced hospitalization or ER visits associated with exacerbations [79] Reduction in dose of OCS [80] compared with placebo	Reduced rate of asthma exacerbations [81] Enhanced asthma-related quality of life, lung function, and asthma control [82] versus placebo	Reduced frequency of exacerbations. Improved lung function and symptoms [83] Reduced OCS use [84] compared with placebo	Reduced number of exacerbations, improved lung function and asthma control [85] Reduction in OCS dose [86] compared with placebo
Adverse events as per label	Injection site reactions, viral infections, upper respiratory tract infection, sinusitis, headache, and pharyngitis	Headache, injection site reaction, back pain, and fatigue	Oropharyngeal pain	Headache and pharyngitis	Injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, and dry eye
Availability in the Gulf	Yes	Yes	No	Yes	Yes