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Mepolizumab

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Mepolizumab, Nucala

  • See Also
  1. Asthma Monoclonal Antibody
  2. Severe Persistent Asthma
  3. Asthma Management
  4. Omalizumab
  5. Benralizumab
  6. Reslizumab
  7. Dupilumab
  • Indications
  1. See Asthma Monoclonal Antibody
  2. Third-line agents for refractory, Type 2 Asthma (Allergic Asthma or Eosinophilic Asthma, represents 50% of Asthma)
    1. Despite long acting Bronchodilator and Inhaled Corticosteroids
  3. One of the following findings present
    1. Blood Eosinophils >150/uL
    2. Sputum Eosinophils >2%
    3. Ferrous Nitrous Oxide >20 parts per billion
    4. Maintenance oral Corticosteroids required
  • Dosing
  1. May be used in age >=6 years old
  2. Adult (age >= 12 years): 100 mg SQ every 4 weeks
  3. Child (age 6 to 11 years): 40 mg SQ every 4 weeks
  4. Subcutaneous (SQ) injection sites include upper arm, Abdomen and thigh
  • Mechanism
  1. Interleukin-5 Antagonist (alpha-directed cytolytic Monoclonal Antibody, IgG1 Kappa)
    1. Similar to Benralizumab (Fasenra)
  2. Binds Interleukin 5 receptor on Eosinophils and Basophils (Asthma-related inflammatory cells)
    1. Marks these inflammatory cells for Natural Killer Cell mediated death
  • Adverse Effects
  1. See Asthma Monoclonal Antibody
  2. Common
    1. Headache (20%)
    2. Injection site reaction (8%)
    3. Back pain (5%)
    4. Fatigue (5%)
  3. Uncommon
    1. Angioedema
    2. Fever
    3. Urinary Tract Infection
  • Safety
  1. Unknown safety in pregnancy (registry exists)
  2. Unknown safety in Lactation
    1. Present in small amounts in Breast Milk
  • Resources
  1. Biologic Therapy in Asthma
    1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405559/
  2. Mepolizumab (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=fefb887c-e4ac-431e-8893-e9d1a5a63fea
  • References
  1. (2022) Comparison of Asthma Medications, Presc Lett, #381217
  2. (2020) Drugs for Asthma, Med Lett Drug Ther 62: 193-200
  3. (2018) Biologics for Asthma, Presc Lett
  4. Narasimhan (2021) Am Fam Physician 103(5): 286-90 [PubMed]
  5. Raymond (2023) Am Fam Physician 107(4): 358-68 [PubMed]
  6. Ortega (2014) N Engl J Med 371(13): 1198-207 [PubMed]