7️⃣ Immunosuppressant Monoclonal Antibodies

What is the prototype monoclonal antibody for asthma?

Omalizumab (Xolair)

What type of antibody is omalizumab?

IgE monoclonal antibody

What is the action of omalizumab?

Binds free IgE → prevents mast cell activation

What does omalizumab reduce?

Asthma exacerbations, hospitalizations

What asthma phenotype is omalizumab used for?

Moderate-severe persistent allergic asthma

What other condition is omalizumab used for?

Chronic idiopathic urticaria

How is omalizumab administered?

Subcutaneous injection

How often is omalizumab given?

Every 2–4 weeks

What determines the omalizumab dose?

Body weight + pretreatment serum IgE

What is omalizumab’s half-life?

26 days

How is omalizumab metabolized?

Reticuloendothelial system, liver

How is omalizumab excreted?

Liver, bile

Why isn’t omalizumab used in acute attacks?

Not for acute bronchospasm

How long to see benefits?

Several months

What is a BLACK BOX WARNING for omalizumab?

Anaphylaxis risk

When can anaphylaxis occur with omalizumab?

After first dose or up to 1 year later

Where must omalizumab be administered?

Healthcare setting — not self-administered

What should patients be taught after omalizumab injection?

Monitor for delayed anaphylaxis

What are common adverse effects of omalizumab?

Injection site reactions, headache, nausea, fatigue

What are symptoms of anaphylaxis?

Bronchospasm, hypotension, urticaria, throat swelling

What is a key safety alert with omalizumab dosing?

Verify correct dose & product — different forms

Can omalizumab be used during pregnancy?

Limited data — use only if clearly needed

Is omalizumab found in breast milk?

Unknown — use caution

What patient teaching is critical for omalizumab?

Signs of anaphylaxis, emergency plan

How should omalizumab doses >150 mg be given?

Divide into multiple injection sites

What improvement should nurse assess with omalizumab?

↓ Asthma exacerbations, ↓ need for steroids, ↑ quality of life

What should be monitored after omalizumab administration?

Signs of anaphylaxis, local reactions

Are there any drug–drug interactions with omalizumab?

None known

Are there any known herbal interactions?

None known

What other monoclonal antibodies target eosinophils?

Mepolizumab, reslizumab, benralizumab

What is mepolizumab’s brand name?

Nucala

What does mepolizumab target?

IL-5

What is reslizumab’s brand name?

Cinqair

What is benralizumab’s brand name?

Fasenra

What phenotype is treated with these antibodies?

Severe eosinophilic asthma

What is dupilumab’s target?

IL-4 & IL-13

What is dupilumab’s brand name?

Dupixent

What is tezepelumab’s target?

TSLP

What is tezepelumab’s brand name?

Tezspire

What is a key teaching point about monoclonal antibodies?

Not for relief of acute bronchospasm

Are these drugs used alone or as add-on?

Add-on maintenance therapy

What is the minimum age for omalizumab?

≥ 6 years old

What is the minimum age for mepolizumab, benralizumab, tezepelumab?

≥ 12 years old

What are common side effects of eosinophil-targeting antibodies?

Injection site reactions, headache, fatigue

Do these agents reduce oral steroid use?

Yes — steroid-sparing

What blood marker should be checked for eosinophilic phenotype?

Blood eosinophil count ≥150/μL

What should the nurse assess during monoclonal antibody therapy?

↓ exacerbations, ↓ need for steroids, ↑ lung function

Why is adherence to scheduled injections important?

Maintain therapeutic effect

What is the goal of monoclonal antibody therapy?

Improve control of severe asthma

What emergency plan should all patients on omalizumab have?

Epinephrine autoinjector & emergency instructions