Monoclonal Antibodies (MAbs) to Treat Asthma

Monoclonal Antibodies (MAbs) to Treat Asthma

Allergic asthma results in allergen-specific IgE by activated B lymphocytes IgE binds to FcεRI receptors on mast cells

Subsequent allergen exposure causes cross-linking of bound IgE, which triggers degranulation of mast cells and release of asthma mediators

Monoclonal anti-IgE antibodies moderate the role of IgE, decrease allergic asthma attack, and treat seasonal allergic rhinitis

MAbs nomenclature: Prefix, Substem A (target), Substem B(souce), and a Suffix (mab)

OMALIZUMAB: OMA (prefix) LI (immune system) ZU (humanized) MAB

Omalizumab - Xolair®

Recombinant humanized monoclonal anti-IgE antibody

Indication: Severe asthma unresponsive to other conventional therapies

MOA: 1. Binds the circulating free (only) lgE (regardless of antigen specificity) and blocks its attachment to the surface of mast cells and basophiles which prevents them from responding (no degranulation and release of inflammatory mediators) 2. Down regulates FcεRI receptors Subcutaneous injection of 150-300 mg every 2-4 weeks (based on lgE level and body weight)

Side effects: Anaphylaxis and/or anaphylactoid reactions possible:

BLACK BOX warning - patients should carry an EpiPen®

Benralizumab - Fasenra®, Mepolizumab - Nucala®, and Reslizumab - Cinqair®

Indication: add-on maintenance treatment of patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype

MOA: an interleukin-5 (IL-5) receptor antagonist. IL-5 is a major cytokine responsible for the growth and differentiation, recruitment, activation, and survival of eosinophils which is responsible for severe treatment-resistant asthma.

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