Asthma Biologics

Question 1

Define severe asthma

Answer 1

-difficult to treat
-uncontrolled despite adhearence and correct technique with high dose ICS-LABA

Question 2

How many adults have severe asthma?

Answer 2

3.7%

Question 3

how are patients with severe asthma identified?

Answer 3

1)confirm asthma diagnosis
2) look for factors making asthma worse
3) Optimized med management
4)review response after 3-6 months

If still uncontrolled, patient has severe asthma

Question 4

Type 2 inflammation

Answer 4

-allergen driven
-high blood eosinophils

-allergic asthma –> exercise induced asthma
-late onset eosinophillic m–> aspiring exacerbated respritory disease

Question 5

Non Type 2 asthma

Answer 5

-obesity associated
-smoking related neutrophilic asthma
-smooth muscle related pauigranulocytic asthma

Question 6

T2 high endotype

Answer 6

-mediated by type 2 inflammatory pathways bc of cytokines IL-4, IL-5, IL-13
-elevated biomarkers: FENO, IgE, eosinophil

Question 7

T2 low endotype

Answer 7

-neutrophilic or pauci-granulocytic inflammation
-normal eosinophil levels

Question 8

Pathobiology of T2-High asthma

Answer 8

-ICS and oral corticosteriods can suppress T2-high phenotype, but not in all patients

Question 9

Omalizumab MOA

Answer 9

-anti IgE
-prevents IgE from binding to cell surface receptors of mast cells and basophills
-inhibits release of inflammatory mediators

Question 10

who is Omalizumab approved for?

Answer 10

-mod to severe asthma
-chronic idiopathic urticaria(itchy)
-Rhinosinusitis w/nasal polyps
-IgE mediated food allergy

Question 11

Omalizumab black box warning

Answer 11

-anaphylaxis

-first 3 injections in clinic
-have to have an epi pen

Question 12

Omalizumab: predictors of positive response

Answer 12

-allergy driven symptoms
-childhood onset asthma
-high eosinophil and FeNo

baseline IgE does BOT predict response

Question 13

Mepolizumab

Answer 13

recombinant, humanized monoclonal anti-IL-5-Ab

Question 14

Reslizumab

Answer 14

IL-5 antagonist monoclonal antibody

Question 15

Who is Reslizumab approved for?

Answer 15

-add on treatment for patients with eosinophilic asthma
-severe eosinophilic asthma

Question 16

Reslizumab black box warning

Answer 16

-anaphylaxis

Question 17

Benralizumab

Answer 17

IL-5Ra cytolytic monoclonal antibody

Question 18

Benralizumab uses

Answer 18

-add on with eosinophilic asthma
-eosinophilic granulomatosis with polyangiitis

Question 19

Benralizumab adverse effects

Answer 19

-headache
-pharyngitis
-fever
-hypersensitivity reactions

Question 20

ANti-IL5/Anti-IL5R efficacy

Answer 20

-higher blood eosinophils
-higher number of exacerbations in the past year
-adult onset asthma
-maintenance oral corticosteroids at baseline
-nasal polyposis

Question 21

Dupilumab

Answer 21

-IL-4Ra/IL-13-Ra1 antagonist, monoclonal antibody

Question 22

Dupilumab in asthma

Answer 22

-maintenance woth mod/severe eosinophilic asthma
-OR with oral corticosteriods dependent asthma

Question 23

Dupilumab: predictors of positive response

Answer 23

-higher blood eosinophils
-higher FeNo

Question 24

who is approved for Tezepelumab?

Answer 24

-patients with severe asthma
-severe exacerbation in the prevous year

DOES NOT REQUIRE EOSINOPHILIC PHENOTYPE

Question 25

Tezepelumab predictors of positive response

Answer 25

-higher blood eosinophils
-higher FeNo

Question 26

Omalizumab eligibility

Answer 26

-total serum IgE and weight within dosage range
-exacerbations in last year

Question 27

dupilumab eligibity

Answer 27

-taking maintenace OCS
-consider comorbid diagnosis

Question 28

Tezepekumab eligibility

Answer 28

-exacerbations in the last year
-Can be used with lower blood eosinophils