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) |
| 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.