Nucala vs. Dupixent: 6 Differences Between These Biologics for Asthma
Nucala (mepolizumab) and Dupixent (dupilumab) are two FDA-approved injections that can treat asthma. Learn how Nucala and Dupixent work and how they differ.
Nucala
Used for Asthma
Used for Asthma
Nucala (mepolizumab) is an injection that treats certain inflammatory problems. This includes severe asthma in people 6 years and older. It can also treat chronic obstructive pulmonary disease (COPD) and sinus congestion with nasal polyps in adults. The medication works as an interleukin antagonist to lower inflammation. It's injected under the skin once a month. You can inject it on your own with the prefilled autoinjector or syringe. A healthcare professional can also give the injection at a medical office. Side effects include headache and injection site reactions.
What is Nucala (mepolizumab)?
What is Nucala (mepolizumab) used for?
- Severe asthma - add-on maintenance for people ages 6 years and older
- Chronic obstructive pulmonary disease (COPD) - add-on maintenance for adults
- Chronic rhinosinusitis with nasal polyps - add-on maintenance for adults
- Eosinophilic granulomatosis with polyangiitis (EGPA) - for adults
- Hypereosinophilic syndrome (HES) - for people ages 12 years and older
How Nucala (mepolizumab) works
Nucala (mepolizumab) is an interleukin antagonist. It blocks a protein in the body called interleukin-5 (IL-5). These proteins help make immune cells called eosinophils, which cause inflammation in the body.
By blocking IL-5, Nucala (mepolizumab) lowers the eosinophil levels in the body. This helps lower inflammation and relieve symptoms from certain inflammatory problems.
When does Nucala (mepolizumab) start working?Time passed since treatment started:
Drug facts
| Common Brands | Nucala |
|---|---|
| Drug Class | Interleukin antagonist |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
More on Nucala (mepolizumab) essentials
Side effects of Nucala (mepolizumab)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache (19%)
- Injection site reactions (e.g., pain, redness, swelling, itching, burning; 8%)
- Back pain (5%)
- Fatigue (5%)
Less Common Side Effects
- Stomach pain
- Muscle spasms
- Itching
- Red or itchy skin (eczema)
- Flu-like symptoms
- Urinary tract infection (UTI)
Note: Side effects listed were reported by people with severe asthma. Side effects might slightly differ for people with other conditions.
Nucala (mepolizumab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic reactions: hives; wheezing; trouble breathing; swelling of face, mouth, tongue, or throat
When do Nucala (mepolizumab) possible side effects begin and end?
Time passed since treatment started:
H
D
W
M
Injection site reaction
More on Nucala (mepolizumab) side effects
The following Nucala (mepolizumab) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
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Pros and cons of Nucala (mepolizumab)
Pros
- Only given once a month
- Available as a prefilled autoinjector and syringe for injections at home
Cons
- Must give as an injection
- Doses higher than 100 mg need more than one injection given one after another
Pharmacist tips for Nucala (mepolizumab)
- Inject Nucala (mepolizumab) once every 4 weeks, or once a month. Mark your calendar or set up reminders on your phone for your injections to help you remember.
- If you miss a dose of Nucala (mepolizumab), inject the medication as soon as you remember. Then, keep following your usual dosing schedule. If it's already time for your next injection, just take the medication like you normally would.
- The spot where you inject Nucala (mepolizumab) might feel sore, red, swollen, or itchy a few hours later. These reactions usually go away on their own in 1 or 2 days. In the meantime, you can use warm or cold compresses or over-the-counter pain relievers to help. But if they get worse or don't go away, tell your care team.
- Don't stop or lower the dose of any steroid medications you take without talking to your care team, even if you feel better with Nucala (mepolizumab). It could make your symptoms worse or cause steroid withdrawal. This can be very uncomfortable. Your prescriber will tell you how to safely lower your dose.
Tips for using Nucala (mepolizumab) at home
- Your care team will show you how to use and inject Nucala (mepolizumab) before you can do it on your own. Review the instructions for use for the prefilled autoinjector or the prefilled syringe. Ask your prescriber or pharmacist if you have any questions about how to inject the medication.
- How to store Nucala (mepolizumab): Keep the medication in the refrigerator until it's time your injection, but don't let it freeze. Keep it in the original carton to protect it from light. If you're traveling or don't have access to a fridge, you can keep unopened cartons at temperatures up to 86ºF for up to 7 days. After that, you'll need to throw it away in a sharps container.
- Before each Nucala (mepolizumab) injection: Take a carton out of the refrigerator and then take out the tray from the carton. Let it sit on a flat surface to warm up. Don't use other ways to warm it. Wait about 30 minutes for the medication to reach room temperature before injecting. Once out of the carton, use the medication within 8 hours or you'll have to throw it away.
- Where to inject Nucala (mepolizumab): Inject under the skin of your thigh or lower stomach (at least 2 inches away from your belly button). Someone can also help you inject it under the skin at the back of the upper arms. Leave at least 2 inches between each spot if you need more than one injection for doses over 100 mg. Don't inject into skin that's bruised, tender, red, or hard to avoid pain or skin irritation.
- When you're ready to inject Nucala (mepolizumab): Take off the needle cap. Inject within 5 minutes. This makes sure the medication doesn't dry in the needle and you get your full dose.
- How to inject using the Nucala prefilled autoinjector: 1) Place the yellow needle guard flat against your skin at a 90-degree angle. 2) Press down and hold it there for the entire injection (takes about 15 seconds). 3) When the injection starts, you'll hear a click and see the inspection window start to turn yellow. 4) After the second click and the window is fully yellow, count to 5 and then lift the autoinjector up.
- How to inject using the Nucala prefilled syringe: 1) Pinch the skin with one hand. 2) With the other hand, insert the entire needle into the pinched skin at a 45-degree angle. 3) Slowly push the white plunger down until all the medication gets injected. 4) Slowly let go of the plunger. The needle will go into the syringe by itself. 5) Let go of your pinched skin when the injection is done.
- After each Nucala (mepolizumab) injection: Throw your used syringes and autoinjectors away in a sharps container or a heavy-duty plastic container, like an empty milk carton or laundry detergent bottle. Don't throw them away in your trash can. This helps prevent everyone from getting hurt from needle sticks.
More on Nucala (mepolizumab) tips
Risks and warnings for Nucala (mepolizumab)
Nucala (mepolizumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Allergic reactions
Nucala (mepolizumab) can cause allergic reactions. Signs include hives, wheezing, or trouble breathing. It can also include swelling of the face, mouth, tongue, or throat or other signs of anaphylaxis.
An allergic reaction can happen a few hours after your Nucala (mepolizumab) injection. But in some cases, an allergic reaction can happen a few days later.
Call 911 right away if you have any signs or symptoms of an allergic reaction after taking Nucala (mepolizumab).
Not for an asthma or COPD attack
Don't use Nucala (mepolizumab) to treat an asthma or COPD attack. It doesn't work fast enough to help with sudden breathing problems. Nucala (mepolizumab) is used as maintenance treatment. It helps control your lung condition in the long run.
Always carry a rescue inhaler like albuterol (ProAir) with you. Use it if you suddenly have trouble breathing. Talk to your prescriber if your breathing gets worse after starting Nucala (mepolizumab).
Caution when using corticosteroids
If you're taking oral or inhaled corticosteroids, don't stop or lower the dose without talking to your care team first. Don't do this even if Nucala (mepolizumab) helps you feel better.
Stopping corticosteroids too quickly can make you have uncomfortable withdrawal symptoms. This includes dizziness, body aches, upset stomach, and trouble sleeping. If you need to stop or lower your corticosteroid dose, your prescriber will help you do it slowly and safely. Follow their directions carefully.
Possible herpes zoster infection (shingles)
It's rare, but some people taking 100 mg of Nucala (mepolizumab) got a herpes zoster infection (shingles). Talk to your prescriber to see if you should get Shingrix, the herpes zoster vaccine. The vaccine can help some people from getting this infection.
Unclear effect in people with parasitic worm infections
It's not clear if Nucala (mepolizumab) affects how your body fights off infections from parasitic worms. Before starting treatment, tell your prescriber if you have a worm infection. You'll need to get it treated first.
Call your care team if you get signs of a parasitic worm infection while taking Nucala (mepolizumab). Watch for stomach pain, nausea, vomiting, diarrhea, skin rash, or itching. Your care team can check if you have a worm infection and treat it. If the infection doesn't get better with treatment, you might need to stop Nucala (mepolizumab) until it goes away.
Nucala (mepolizumab) dosage
Syringe| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 40mg/0.4ml | 1 syringe | $1,538.80 | $1,538.80 |
Typical dosage for Nucala (mepolizumab)
-
Severe asthma
- People 12 years and older: The typical dose is 100 mg injected under the skin once every month.
- Children 6 to 11 years old: The typical dose is 40 mg injected under the skin once every month.
-
COPD
- Adults: The typical dose is 100 mg injected under the skin once every month.
-
Chronic rhinosinusitis with nasal polyps
- People 18 years and older: The typical dose is 100 mg injected under the skin once every month.
-
EGPA
- Adults: The typical dose is 300 mg injected under the skin once every month. It's given as three separate 100 mg injections, given one right after the other.
-
HES
- People 12 years and older: The typical dose is 300 mg injected under the skin once every month. It's given as three separate 100 mg injections, given one right after the other.
How much does Nucala (mepolizumab) cost?
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Nucala (brand)
$1,538.80
What are alternatives to Nucala (mepolizumab)?
There are a number of medications that your doctor can prescribe in place of Nucala (mepolizumab). Compare a few possible alternatives below.
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Nucala (mepolizumab) images
