Mepolizumab is a humanized immunoglobulin G1 kappa monoclonal antibody specific for interleukin 5 (IL-5). Mepolizumab binds to IL-5 and therefore stops IL-5 from binding to its receptor on the surface of eosinophils. Inhibiting IL-5 binding to eosinophils reduces blood, tissue, and sputum eosinophil levels. It is indicated for add-on maintenance treatment of patients with severe asthma and with an eosinophilic phenotype.
According to updated ERS/ATS guidelines, blood eosinophil counts and FeNO levels may be useful in choosing patients more likely to achieve a more positive effect on exacerbations and lung function when treated with omalizumab; however, the panel advises cautious use of biomarker thresholds, as patients with eosinophil or FeNO values below proposed cut-offs (blood eosinophil level ≥ 260 µL−1 and FENO ≥ 20 ppb) may still benefit from omalizumab.
The use of methotrexate in patients with severe asthma is not recommended, owing to probable adverse effects and the need to monitor therapy.
Because of the development of antibiotic resistance and uncertain clinical benefits, routine use of macrolide antibiotics for the treatment of severe asthma or exacerbations is discouraged.
For more on the treatment of severe asthma, read here.
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Cite this: Zab Mosenifar. Fast Five Quiz: Test Your Knowledge of Severe Asthma - Medscape - May 18, 2020.