Table 1:
Type 2 biologic medications for severe asthma
| Target | Dose | Primary treatment group | Primary benefits | Stage of development | |
|---|---|---|---|---|---|
| Mepolizumab (GlaxoSmithKline, Brentford, UK) | IL-5 | Subcutaneous, 100 mg, Q4 weeks | Severe eosinophilic asthma (≥150 cells per μL at screening or ≥300 cells per μL in past year) | Considerable improvement in asthma exacerbations and symptoms; mild improvement in FEV1 and steroid sparing | FDA approved for severe eosinophilic asthma |
| Reslizumab (Teva Pharmaceuticals, Petah Tikva, Israel) | IL-5 | Intravenous, 3·0 mg/kg, Q4 weeks | Moderate to severe eosinophilic asthma (≥400 cells per μL) | Considerable improvement in asthma exacerbations; mild improvement in FEV1 and symptoms | FDA approved for severe eosinophilic asthma |
| Benralizumab (MedImmune, Gaithersburgh, USA; and AstraZeneca, Cambridge, UK) | IL-5RA | Subcutaneous, 30 mg, Q8 weeks | Severe eosinophilic asthma (≥300 cells per μL) | Considerable improvement in asthma exacerbations; mild improvement in FEV1 and steroid sparing | FDA approved for severe eosinophilic asthma |
| Lebrikizumab (Genentech, San Francisco, USA; and Roche, Basel, Switzerland) | IL-13 | Subcutaneous, 38–125 mg, Q4 weeks | Severe asthma with periostin concentrations ≥50 ng/mL or blood eosinophils ≥300 cells per μL | Mild improvement in asthma exacerbations | No longer in development for asthma |
| Pitrakinra (Amgen, Thousand Oaks, USA) | IL-4RA | Subcutaneous, 25 mg once a day or 60 mg nebulised twice a day | Atopic asthma | Modest efficacy in allergen challenge model | No longer in development for asthma |
| Dupilumab (Regeneron, Tarrytown, USA; and Sanofi, Paris, France) | IL-4RA | Subcutaneous, 200 or 300 mg, Q4 weeks | Moderate to severe eosinophilic asthma (>300 cells per μL) | Considerable improvement in asthma exacerbations, FEV1, and symptoms; mild improvement in steroid sparing | FDA approved for moderate to severe eosinophil asthma or oral corticosteroid-dependent asthma |
| Tezepelumab (Amgen; and MedImmune) | TSLP | Subcutaneous, 70 mg Q4 weeks, 210 mg Q4 weeks, or 280 mg Q2 weeks | Moderate to severe asthma | Considerable improvement in asthma exacerbations; mild improvement in FEV1 and symptoms | Ongoing phase 3 trial |
| REGN3500 (Regeneron) | IL-33 | Subcutaneous, dose to be determined | Moderate to severe eosinophilic asthma (≥300 cells per μL) | Mild improvement in loss of asthma control and FEV1 | Recently completed phase 2B trial |
FEV1=forced expiratory volumes in 1 s. FDA=US Food and Drug Administration. Q2=every 2 weeks. Q4=every 4 weeks. Q8=every 8 weeks.