From: How safe are the biologicals in treating asthma and rhinitis?
Biological agent | Disease studied | Target | Mechanisms | Safety | Efficacy |
---|---|---|---|---|---|
SCIT | AR & asthma | Specific aeroallergens or venom | Several immune changes including↑IL-10 & TGF-β. isotype switch to IgG | Surveys suggest; fatality rate of 1 in 2.5 million injections34-36 & near fatal reaction rate of 5.4 per 1 million injections37 | Appears to depend on dose |
SLIT | AR & asthma | Specific aeroallergens | Probably similar to SCIT | Most common AEs oral-mucosal symptoms AE less common than SCIT but cases of anaphylaxis have been reported | A consistent relationship with dose and efficacy has not been established39 |
MPL | AR | TRL4 | Shift toward Th1 response | SRs reported in 1.6% of the 1736 patients in postmarking surveillence survey50 | Clinical efficacy seen in first treat season after 4 injection treatment course |
CpG | AR | TRL9 | Shift toward Th1 response | No serious treatment-related effects46 | Clinical efficacy seen in 1st & 2nd treatment season after one 4 injection course46 |
Omalizumab | Asthma & AR | IgE | Prevents binding of IgE to mast cells and basophils, downregulatuion of IgE receptor on these cells | Anaphylaxis in 0.09 to 0.2% of patients19,20 | Efficacy in medication reduction & exacerbation in asthma, clinical improvement in AR |
Mepolizumab | Asthma | IL-5 | Blocks binding of IL-5 to α receptor on eosinophils | One episode of hypotension after infusion in EE study57 | No significant improvement in asthma55 |
Pintrakinra58 | Asthma | IL-4Rα receptor | Competes with IL-4 and IL-13 for binding to the receptor | Non-neutralizing IgG anti- pintrakinra antibodies in ~30% of pts | Increased PD20 inmethacholine challenge & asthma AE & beta-agonist use |
Etanercept | Asthma | TNF-alpha | soluble TNF-alpha receptor | No significant treatment-related AE is asthma 59 but increased risk of serious & opportunistic infection in rheumatologic disease | Increased markers of TNF-alpha activity & improved clinical outcomes in refractory asthma 59 |