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

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 and older with asthma.

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.

You should receive the first few doses of Xolair in a healthcare setting. Since severe allergic reactions (or anaphylaxis) are possible, your healthcare team can monitor you for possible signs and symptoms of anaphylaxis and take quick action if it occurs. If the first few doses go to plan, then your prescriber will likely tell you that you can inject Xolair 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 Nucala at home once a healthcare professional shows you how to inject it.

You will inject Nucala every 4 weeks, but your specific dose depends on your age. For asthma, Nucala is approved for people ages 6 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 and older. The dose is calculated based on age and body weight, and it’s injected under the skin at home. For people ages 12 and older, it’s recommended to receive a loading dose before the very first injection. This kickstarts the dosage process and only needs to be done once. After that, Dupixent is given every 2 to 4 weeks.

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 excess  inflammation.

Fasenra is approved for people ages 6 and older. It’s given as an injection under the skin at home.

People ages 12 and up receive a standard 30 mg dose. Children ages 6 to 11 who weigh less than 77 lbs (35 kg) should receive a lower 10 mg dose. Children in this age group who weigh 77 lbs or more receive the standard 30 mg dose.

A benefit of Fasenra is that you’ll need fewer injections overall compared to many other options. 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 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, and you’ll likely need to be monitored for a short time afterwards to make sure you tolerate it well. You can’t inject it under the skin. Your dose of Cinqair will be calculated by a healthcare professional based on your body weight.

6. Exdensur

Exdensur (depemokimab) treats adults and adolescents ages 12 and older living with severe eosinophilic asthma. Like Nucala and Cinqair, it works by targeting IL-5, a molecule that plays a role in the growth and survival of eosinophils. Exdensur helps reduce airway inflammation and improve asthma management.

What sets Exdensur apart is how long it lasts in the body. It’s given as an injection under the skin by a healthcare professional, but it’s not administered as frequently as other asthma biologics. After starting treatment, Exdensur is typically injected once every 6 months. It’s a convenient option to consider for people who prefer fewer injections each year.

7. Tezspire

Tezspire (tezepelumab) 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 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 healthcare professional 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 seven biologics are FDA approved for different types of asthma and work in slightly different ways. It’s best to talk to your healthcare team about which one is most appropriate for your age and 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:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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