- What are biologic treatments for asthma?
- How do biologic treatments work?
- How can I get access to biologic treatments?
- What biologic treatments are available for asthma?
- Taking biologic treatments
- Reviewing your treatment
- What are the benefits of biologic treatments?
- Risks and side effects of biologic treatments
- Biologic treatments and pregnancy
What are biologic treatments for asthma?
Biologics are a specialist treatment which can help you to control your asthma symptoms better. Your specialist might call biologics monoclonal antibodies or mAbs.
They’re available for certain types of severe asthma which are not well controlled with high doses of steroid inhalers. These include:
- type 2 inflammation, which includes eosinophilic and allergic asthma. Biologics for type 2 inflammation target molecules that are involved in the build-up of inflammation in your airways.
- non-type 2 inflammation. If you have this type of asthma, you're likely to have a normal level of eosinophils in your blood. Biologic treatment for non-type 2 inflammation stops your airways reacting as much to triggers.
How do biologic treatments work?
Biologic treatments work using antibodies made from cells in a laboratory. The antibodies target specific cells in your body’s immune system that cause inflammation in your lungs. The inflammation may be caused by allergies or by high levels of a cell in your body called an eosinophil.
What are eosinophils?
Eosinophils are a type of white blood cell that can cause inflammation in your lungs. People with severe asthma sometimes have high levels of eosinophils in their blood. This can be shown with a blood test called an eosinophil count which works out the number of eosinophils in your blood.
Your eosinophil levels are important as they can help your specialists decide:
- what type of asthma you have
- what treatments you need
- if biologics are right for you.
Some medicines can reduce your eosinophil count result like oral corticosteroids. You still need to take your asthma medicines as prescribed though. If you have any questions speak to your specialist.
How can I get access to biologic treatments?
Biologics are a specialist, targeted treatment. There are strict criteria for who can access them.
You need to be referred to a specialist severe asthma service before you can be considered for biologic treatments.
At the clinic, your specialists will assess:
- your symptoms
- your inhaler technique
- how well you’ve been able to stick to your medicine routine
- what type of severe asthma you have.
Afterwards a specialist team will talk through your test results with you. Your specialist will recommend biologic treatment if you meet the necessary criteria for accessing these treatments and if you’ve been taking all your medicines as prescribed.
They will discuss the best biologic for you to try. If you’re eligible for more than one biologic you should be offered a choice. Your specialist will help you decide which one is right for you.
On average it takes about a year and a half to get a biologic after being referred to a severe asthma service. But it can vary.
The time it takes for you to get a biologic can depend on:
- how well you’ve been taking your current medicines
- any other conditions you have
- how well matched you are to a biologic treatment (how closely you meet the criteria to access the biologic).
What biologic treatments are available for asthma?
There are currently six biologic treatments approved for use in the UK and available on the NHS to treat severe asthma.
| Name of biologic | What type of asthma does it treat? | How often do I need to have it? |
|---|---|---|
| Mepolizumab (Nucala) | type 2 inflammation | injection given every four weeks |
| Reslizumab (Cinqaero) | type 2 inflammation | given through a drip every four weeks |
| Benralizumab (Fasenra) | type 2 inflammation | injection given every four weeks for the first three treatments and then every eight weeks |
| Omalizumab (Xolair and Omlyclo) | type 2 inflammation | injection given every two to four weeks |
| Dupilumab (Dupixent) | type 2 inflammation | injection given every two weeks |
| Tezepelumab (Tezspire) | type 2 and non-type 2 inflammation | injection given every four weeks |
The biologic treatment criteria are:
Mepolizumab is suitable for people aged six years and above. It’s known by the brand name Nucala.
You may be offered mepolizumab if:
- your blood eosinophil count has reached 300 cells or more and
- you’ve had four or more asthma attacks needing steroid tablets or injections in the past 12 months or
- you've been taking steroid tablets continuously, at least equivalent to 5mg of prednisolone per day, over the previous six months.
Reslizumab is suitable for adults aged 18 and over. It’s known by the brand name Cinqaero.
You’ll only be offered reslizumab if:
- your blood eosinophil count has reached 400 cells or more and you’ve had at least three or more asthma attacks needing steroid tablets or injections in the past 12 months and
- you’re based in England, Wales or Northern Ireland. It’s not available in Scotland.
Benralizumab is suitable for adults aged 18 and over. It‘s known by the brand name Fasenra.
You may be offered benralizumab if:
- your blood eosinophil count has reached 300 cells or more and
- you’ve had four or more asthma attacks needing steroid tablets or injections in the past 12 months or
- your blood eosinophil count has reached 400 cells or more and
- you’ve had three or more asthma attacks needing steroid tablets or injections in the past 12 months or
- you've been taking steroid tablets continuously over the past six months. The steroid dose must be at least the same as 5mg of prednisolone per day.
Omalizumab is suitable for people aged six years old and over. It’s known by the brand names Xolair and Omlyclo.
You may be offered omalizumab if:
- you’ve been taking a steroid tablet continuously in the previous year or needed at least four courses of steroids in the past 12 months and
- you have:
- reduced lung function
- frequent symptoms during the day
- wake up at night with your asthma
- had a positive skin prick test for allergies.
Omalizumab can also treat rhinosinusitis with nasal polyps. Rhinosinusitis with nasal polyps is where the lining of your nose and sinuses is inflamed for longer than 12 weeks. The condition is more common in people with asthma. Omalizumab is safe to use alongside antihistamines and other treatments for rhinosinusitis.
It can take 12-16 weeks for omalizumab to show benefits. If your symptoms have improved after 16 weeks, you’ll be able to continue your treatment.
Dupilumab is suitable for ages 12 and over. It’s known by the brand name Dupixent.
You may be offered dupilumab if:
- you've had two or more courses of oral steroid tablets, or stayed overnight in hospital for your asthma in the last 12 months and
- you have a blood eosinophil count of 150 cells or more and fractional exhaled nitric oxide (FeNO) of 25 parts per billion or more and
- you've had four or more asthma attacks in the previous 12 months and
- you're not eligible for other biologics or your asthma has not responded well enough to other biologic treatments.
Tezepelumab is suitable for people who are 12 and over. It‘s known by the brand name Tezspire.
Unlike other biologics, you can access tezepelumab without the need for specific biomarkers in your blood, like an eosinophil count.
You may be offered tezepelumab if:
- you’ve had three or more exacerbations in 12 months or
- you’re taking long-term oral steroids.
Taking biologic treatments
Going to clinic
You’ll usually need to visit a specialist asthma clinic to start treatment.
Your nearest specialist clinic may not be in your local area, so you'll need to allow for the cost and time of travel.
You may need to stay in the clinic for a couple of hours after your first few treatments. This is to make sure you do not have a severe reaction to the treatment. You might want to arrange for someone to take you to the clinic, so you do not have to drive afterwards.
After you’ve been for treatment three or four times at the clinic, you may be allowed to inject yourself at home. Your specialist will discuss this with you and help you to decide whether this is a good option for you.
Self-injecting at home
Being allowed to self-inject at home will depend on which biologic you’re taking and your medical history.
If you have a history of severe allergic reactions (anaphylaxis) your injections should always be given to you by a healthcare professional in a specialist clinic.
If you decide to self-inject, your specialist team will give you training and provide you with the medication you need. The biologics come in pre-filled syringes and pens in multi-packs.
How to store biologics
If you’re using biologics at home, you need to store them safely. Your specialist team can advise you about this.
You must:
- store them in the fridge
- keep them in their original packaging
- keep them away from light
- store them out of reach of children
- use them by the expiry date.
Reviewing your treatment
Whatever biologic you’re prescribed, your specialist will review your treatment three to four months after you start the treatment to make sure it’s working for you.
This is because it may take this length of time for your symptoms to improve. Your specialist may use tests to see how well your biologics working, such as spirometry, FeNO, blood tests.
You may also be asked to complete a quality-of-life questionnaire. The questionnaire will ask you questions about your asthma and how it affects you in your daily life. It can help your specialist understand how well you’re coping.
After your first review, your treatment should be reviewed every three to six months.
If your asthma improves with the biologic treatment, you should keep having your treatment for at least a year before you consider stopping it. You may be able to reduce the long-term steroid tablets you’re taking for your asthma.
If your biologic treatment is not working well, you might need to stop or change your treatment. Your specialist will discuss your treatment options with you. You may need further investigations to confirm which type of asthma you have.
Contact your healthcare team if
- Your asthma symptoms are not improving
- Your asthma symptoms are getting worse
Do not stop taking either your usual asthma medicines or your biologic treatment unless your doctor tells you to. Stopping or interrupting treatment could make your symptoms come back.
What are the benefits of biologic treatments?
Biologic treatments can:
- allow some people to stop or reduce the dose of their oral steroids and lower the risk of side effects from these.
- help people with severe asthma manage their symptoms
- reduce asthma attacks.
Keep taking your usual asthma medicines
Never reduce or stop taking any of your asthma medicines without discussing you’re your specialist team. They will advise if and when this can be done safely.
Risks and side effects of biologic treatments
As with all medicines, biologic treatments can have risks and side effects.
The patient information leaflet for your biologic treatment will list all the possible risks and side effects. You should read the leaflet carefully and speak to your specialist before starting your treatment.
Common side effects
Some common side effects (affecting up to 1 in 10 people) include:
- headache
- sinus pain
- sore throat
- soreness at the injection site. This should go away in a few days and may improve after you’ve had the injection a few times.
Severe allergic reactions
Sometimes biologic treatments for asthma can increase the risk of a severe allergic reaction (anaphylaxis) for some people. The risk is rare (1 in 1000) and more likely if you have a history of allergic reactions or anaphylaxis.
Because of this, you may be asked to stay in the clinic for a short time after your first few treatments. It’s best to be surrounded by people who can give you the right help if you have an allergic reaction.
If you self-inject your biologic treatment at home, it’s important to know the signs of a severe allergic reaction, such as difficulty breathing, swelling, or feeling dizzy or unwell.
Call 999 if
- your lips, mouth, throat or tongue suddenly become swollen
- you're breathing very fast or struggling to breathe (you may become very wheezy or feel like you're choking or gasping for air)
- your throat feels tight or you're struggling to swallow
- your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
- you suddenly become very confused, drowsy or dizzy
- someone faints and cannot be woken up
You may also have a rash that's swollen, raised or itchy. These can be signs of a serious allergic reaction and may need immediate treatment in hospital.
Parasitic infection
In rare cases, taking biologics can mean your body is not as good at fighting off parasitic infections such as cyclospora, intestinal worms, or malaria.
Get advice from your doctor if you’re travelling to regions in the world where parasitic infections are more common than they are in the UK.
Biologic treatments and pregnancy
If you’re using biologics, you can usually continue to take them during pregnancy and while breastfeeding. But it may mean your baby cannot be given certain vaccines, including the rotavirus and BCG vaccines. Speak with your specialists or midwife for more advice.
Get support
Call our helpline for support with your condition. Get advice on your medicines, symptoms or travelling with a lung condition, or just call us to say hello.
