Table 1.

Characteristics of approved monoclonal antibody treatments for severe eosinophilic asthma

Characteristic	Omalizumab	Mepolizumab	Reslizumab	Benralizumab	Dupilumab	Tezepelumab
Mechanism	Anti-IgE	Anti-IL5	Anti-IL5	Anti-IL5Rα	Anti-IL4Rα	Anti-TSLP
Indication	Severe asthma	Severe asthma	Severe asthma	Severe asthma	Severe asthma	Severe asthma
Drug form	Prefilled syringe	Prefilled syringe, autoinjector pen	Intravenous infusion	Prefilled syringe, autoinjector pen	Prefilled syringe, autoinjector pen	Prefilled syringe
Licensed patient age	≥6 yr	≥6 yr	≥18 yr	≥12 yr	≥6 yr	≥12 yr
Safety concerns	Injection site reactions (2–10%), hypersensitivity reactions (<1%)	Injection site reactions (2–10%), hypersensitivity reactions (<1%), shingles (rare), helminth infection (rare)	Injection site reactions (2–10%), hypersensitivity reactions (<1%), helminth infection (rare)	Injection site reactions (2–10%), hypersensitivity reactions (<1%), helminth infection (rare)	Injection site reactions (2–10%), hypersensitivity reactions (<1%), hypereosinophilia (3%), conjunctivitis, helminth infection (rare)	Injection site reactions (2–10%), hypersensitivity reactions (<1%), pharyngitis, arthralgia, back pain
Typical patient group	Allergic asthma, childhood onset	Eosinophilic asthma, adulthood onset	Eosinophilic asthma, adulthood onset, polysorbate allergy	Eosinophilic asthma, adulthood onset	Eosinophilic or allergic asthma, childhood or adulthood onset	Eosinophilic or allergic asthma, adulthood onset, type 2 low asthma
Key biomarker(s) for response	Serum IgE (for dosing)	Raised blood eosinophils	Raised blood eosinophils	Raised blood eosinophils	Raised blood eosinophils and FeNO	Raised blood eosinophils and FeNO
Co-existing conditions treated by biologic	Chronic spontaneous urticaria, allergic rhino-conjunctivitis	ABPA, EGPA, chronic rhinosinusitis with nasal polyposis	Chronic rhinosinusitis with nasal polyposis	Chronic rhinosinusitis with nasal polyposis	Chronic rhinosinusitis with nasal polyposis, atopic dermatitis (eczema)	Chronic rhinosinusitis with nasal polyposis
Effect on blood eosinophil	↓	↓↓	↓↓	↓↓	↑ (returns to baseline after 1 yr)	↓
Effect on FeNO	↓	None	None	None	↓↓	↓↓
Effect on serum IgE	None	None	None	None	↓	↓
Effect on exacerbations	↓	↓↓	↓↓	↓↓	↓↓	↓↓
Effect on FEV1	None	↑	↑	↑	↑↑	↑↑
Oral steroid sparing	No	Yes	Yes	Yes	Yes	No (trial ongoing)

EGPA, eosinophilic granulomatosis with polyangiitis; ABPA, allergic bronchopulmonary aspergillosis; FeNO, fraction exhaled nitric oxide.