An Update on New Treatments for Asthma
Asthma is a common health condition affecting 1 in 12 adults and 1 in 10 children. The incidence of asthma is in fact increasing. While many patients can be managed with traditional treatments, 5-10% of patients do not respond to such therapy. Fortunately, research has led to the development of other treatments that have proven to be life-changing. Below is a short summary regarding some of the newer treatments for uncontrolled asthma. Of course, these treatments are not indicated for everyone and we would recommend consulting your Allergy Partners physician for more information to see if one of these medications is right for you. Ultimately, the right treatment should be able to control your asthma so that it does not interfere with your life. Many Olympians in fact have asthma which goes to show that when asthma is controlled with the right medications, it should never limit one’s activities.
IgE is a type of antibody that causes allergic reactions including asthma. A medication called Xolair binds to IgE and inhibits the activation of allergy-type cells. Xolair is indicated for patients 6 years and older with allergies and uncontrolled asthma. It is also approved for the treatment of another condition with chronic, daily hives. In regards to asthma, Xolair has been shown to decrease the risk of asthma attacks and improve quality of life. It is administered as an injection every 2-4 weeks, and the most serious adverse effect (though very rare) is a life-threatening allergic reaction. Hence, Xolair must be administered in a healthcare setting for close observation.
Anti-IL5: Nucala, Cinqair and Benralizumab
Eosinophils (a specific type of allergy-related cell) are not normally present in healthy lungs, but they can be present in a small group of asthma patients that sometimes do not respond to typical treatments. Upon activation, these cells release signals that promote inflammation and asthma attacks. Nucala and Cinqair are the newest approved medications and inactivate IL5 which is critical for the survival of eosinophils.
Nucala was approved in 11/2015 for patients aged 12 years and older with uncontrolled asthma and elevated eosinophil counts. Nucala causes a decrease in eosinophils and subsequently a decrease in airway inflammation leading to less asthma attacks and improved quality of life. Like Xolair, Nucala is administered as an injection every 4 weeks.
Cinqair was approved in 03/2016 for patients 18 years and older with uncontrolled asthma and elevated eosinophil counts. While Cinqair has similar effects compared to Nucala, Cinqair is an IV infusion. There is a small risk of developing an allergic reaction to both Nucala and Cinqair, and thus both need to be administered in a healthcare setting for proper observation.
While Nucala and Cinqair bind to IL5 and block its effects, Benralizumab binds to the IL5 signal receptor on eosinophils subsequently inducing death in these cells. Initial Benralizumab trials have been promising, and it could be approved for asthma as soon as this fall.
Anti-IL4 and Anti-IL13: Dupixent
Dupixent blocks the receptor of two cell signals (IL4 and IL13) that promote inflammation and allergic responses similar to IL5 as above. Early studies with Dupixent for the treatment of asthma were very promising. While not officially approved for asthma quite yet, Dupixent was approved in 03/2017 for the treatment of adult patients with allergic eczema. It is a self-administered injection given every other week. The results of additional asthma studies are said to be forthcoming.