Written by Dr. Jeffrey Weiss, M.D.

What are Biologics?

The newest treatment options for historically frustrating conditions — like severe asthma, chronic idiopathic urticaria, nasal polyps, atopic dermatitis, eosinophilic esophagitis, and antibody deficiencies — are called “Biologics.”  Biologics are monoclonal antibodies – which are defined as a single cell line that produces identical antibodies.  What this means is we can provide targeted treatment with minimal to no adverse side effects.

The best way I like to describe biologic treatment to my patients is sharing a story from when I was a second-year medical student in 1995.  I was sitting in a Pharmacology lecture and learning about chemotherapy.  The professor was teaching us about how most of the cancer medications worked at the time, in which the chemotherapy medications would destroy both the cancer cells and the healthy cells.  The plan was to essentially hope the patient will survive the treatment.  Then the professor went on to say – “wouldn’t it be nice if one day we can design medications that can tell the difference between the cancer cells and the healthy cells.  That way we would be able to treat with minimal to no adverse effects because we would only destroy the unhealthy cells and leave the healthy cells intact.”

This was at a time when the concept of biologics was in its infancy and the early biologics were first being developed.  But this is what biologics are in a nutshell – laser focused treatment that results in a more effective treatment with minimal to no adverse effects.

Biologics have been on the market since the 1980s, but in the past two decades their use has become mainstream across all different medical specialties – including Gastroenterology, Neurology, Rheumatology, Hematology/Oncology, and Allergy, Asthma and Immunology.   This educational series will focus on biologics for medical conditions that fall under our specialty of Allergy, Asthma and Immunology at Impact Medical.

Examples of Biologics used in Allergy, Asthma, and Immunology

Omalizumab (Xolair)

Monoclonal antibody that binds to circulating IGE in the bloodstream. This prevents the binding of IGE to the high-affinity IGE Receptor (FcεRI) on the surface of allergy cells (mast cells and basophils), therefore limiting the release of mediators of the allergic response.

Dosing Frequency: Subcutaneous injection every 2-4 weeks

Dupilumab (Dupixent)

Monoclonal antibody that inhibits IL-4 and IL-13 signaling by specifically binding to the IL-4 receptor alpha subunit. This lessens allergic inflammation.

Dosing Frequency: Subcutaneous injection every 2 weeks

Mepolizumab (Nucala)

Monoclonal antibody that specifically targets IL-5 and binds to it. This inhibits IL-5 signaling, reducing the production and survival of eosinophils. Eosinophils are one of the main inflammatory cells involved in allergic inflammation.

Dosing Frequency: Subcutaneous injection every 4 weeks.

Benralizumab (Fasenra)

Antibody that directly binds to the alpha subunit of the IL-5 receptor on eosinophils. This leads to programmed cell death or apoptosis of Eosinophils. Eosinophils are one of the main inflammatory cells involved in allergic inflammation.

Dosing Frequency: Subcutaneous injection every 4 weeks X 3 doses, then every 8 weeks

Tezepelumab-ekko (Tezspire)

Monoclonal antibody that targets a protein called thymic stromal lymphopoietin (TSLP) which is a protein within the Alarmin cytokine family that initiates and perpetuates airway inflammation.

Dosing Frequency: Subcutaneous injection every 4 weeks

If you would like to further discuss asthma treatment options, please schedule an appointment at Impact Medical – Allergy, Asthma and Immunology.