6 Biologics for Asthma: What to Know About Breathing Easier With Xolair, Nucala, and More

The start of the 21st century brought a new kind of treatment option for moderate-to-severe asthma — biologics. These medications are generally add-on treatments to traditional asthma treatments, such as inhalers.

These medications work differently than inhalers or oral asthma treatments. They’re more precise and target specific molecules in the body that are linked to worsening asthma symptoms. Asthma biologics are reserved for people who are using their inhalers properly and avoiding triggers, but are still having symptoms.

There are six different asthma biologics to choose from. They’re all supplied as injections or infusions, but they work in different ways. Some can be given at home while others are only given in a healthcare setting. Here’s how they compare to one another.

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1. Xolair

Xolair (omalizumab) became the first FDA-approved biologic for asthma in 2003. It treats moderate-to-severe allergic asthma. Xolair targets an antibody called immunoglobulin E (IgE) and blocks a pathway that causes allergy-related asthma symptoms. It can be used by adults and children ages 6 years and older.

Xolair should be injected under the skin (subcutaneously) every 2 to 4 weeks. The dose of Xolair depends on your measured IgE levels, age, and body weight. But the physical location where you should receive your Xolair injections can vary.

This is because severe allergic reactions (or anaphylaxis) are possible with Xolair. The first few doses should be given in a healthcare setting so they can monitor you for possible signs and symptoms of anaphylaxis. If the first few doses go to plan, then a healthcare professional (HCP) will likely tell you that you can inject it at home moving forward.

2. Nucala

Nucala (mepolizumab) treats severe eosinophilic asthma, which is caused by an overcrowding of white blood cells called eosinophils. These cells can cause unnecessary inflammation and contribute to asthma symptoms. Nucala targets and blocks a molecule called interleukin-5 (IL-5) to limit eosinophil growth and activation. This helps prevent excessive inflammation.

Similar to Xolair, Nucala is also given as an injection under the skin. But unlike Xolair, you don’t need to be monitored in a healthcare setting first. It’s safe to use at home once an HCP shows you how to use it.

You will inject Nucala every 4 weeks, but your specific dose depends on your age. Nucala is approved for people ages 6 years and older.

3. Dupixent

Dupixent (dupilumab) casts a wider net than Xolair and Nucala. It’s approved to treat two different types of asthma.

The first use is for moderate-to-severe eosinophilic asthma. This is slightly different from Nucala, which is only approved for severe eosinophilic asthma. It works differently than Nucala, too, since Dupixent blocks the receptor (chemical binding site) of interleukin-4 (IL-4). This prevents the actions of IL-4 and interleukin-13 (IL-13), which in turn lowers inflammation and improves lung function. The second use is for asthma that regularly requires oral steroids to manage symptoms.

For both types of asthma, Dupixent is approved for people ages 6 years and older. The dose is calculated based on age and body weight, and it’s injected under the skin. For people ages 12 years and older, it’s recommended to receive a loading dose before the very first injection. This kickstarts the dosing process and only needs to be done once. After that, Dupixent is given every 2 to 4 weeks.

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4. Fasenra

Like Nucala, Fasenra (benralizumab) also treats severe eosinophilic asthma. It works by blocking the IL-5 receptor — not IL-5 itself. This prevents eosinophils from causing too much inflammation.

Fasenra is approved for people ages 12 years and older. It’s given as an injection under the skin at a consistent dose of 30 mg. A benefit of Fasenra is needing fewer injections overall. It should be injected every 4 weeks for the first 3 doses, then once every 8 weeks (2 months).

5. Cinqair

Cinqair (reslizumab) treats severe eosinophilic asthma, too. Like Nucala, it blocks IL-5 and prevents excessive inflammation. It’s meant for adults ages 18 years and older. Cinqair is not approved for kids or teens.

Of the medications on this list, Cinqair is the most time consuming. You would receive it every 4 weeks as an IV infusion in a healthcare setting. The infusion typically takes between 20 to 50 minutes. You can’t inject it under the skin. Your dose of Cinqair will be calculated by a HCP based on your body weight.

6. Tezspire

Tezspire (tezepelumab or tezepelumab-ekko) is more unique. It works by blocking a protein called thymic stromal lymphopoietin (TSLP), which reduces inflammation in your airway. A benefit of using Tezspire is it can be used to treat any type of severe asthma. It doesn’t matter if you have eosinophilic or allergic asthma.

This medication is given as an injection under the skin and can be prescribed to people ages 12 years and older. The dose is 210 mg injected every 4 weeks. But one drawback of Tezspire is injections are usually given in a healthcare setting. A HCP has to train and clear you (or a caregiver) before you can do any injections at home.

How do you know which asthma biologic is right for you?

The “best” asthma biologic isn’t the same for everyone. These six biologics are FDA approved for different types of asthma and work in slightly different ways. It’s best to talk to your HCP about which one is most appropriate for your specific type of asthma.

Some of these biologics can also be used for other conditions, such as eczema, rhinosinusitis (inflammation of the sinuses), or chronic urticaria (hives). If you’re also battling one of these conditions, you may be able to take one biologic for both.

What’s more, not all of the biologics are injected under the skin at home. And keep in mind that some biologics require more frequent injections than others. These are big factors to consider if convenience is important to you. Their similarities and differences are summarized in the table below.

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Written by:

Hindu Rao, PharmD, APh, BCACP

Hindu Rao, PharmD, APh, BCACP is a clinical assistant professor of pharmacy practice at Chapman University School of Pharmacy and a clinical pharmacist at Providence Medical Foundation. She specializes in chronic disease management and has her board certification in ambulatory care.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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