Three monoclonal antibody therapies (benralizumab, mepolizumab and omalizumab) are available in Australia for the treatment of patients with severe asthma whose asthma is uncontrolled despite optimised standard treatment.
This information paper is a new evidence-based resource for primary care health professionals to help explain the latest treatment options for patients with severe asthma.
- Benralizumab, mepolizumab and omalizumab are monoclonal antibody therapies used in the treatment of people with severe asthma whose asthma is uncontrolled despite optimised standard treatment, including high-dose inhaled corticosteroids and long-acting beta2 agonists.
- Monoclonal antibody therapies target inflammatory pathways that activate immune responses leading to airway inflammation.
- Monoclonal antibody therapies can be prescribed with Pharmaceutical Benefits Scheme (PBS) subsidy by certain specialists for patients attending an approved public or private hospital.
- After treatment has been initiated by a specialist, ongoing maintenance doses can be administered in primary care.
- Monoclonal antibody therapies have been shown to reduce the frequency of severe asthma flare-ups (worsening asthma requiring oral corticosteroids, emergency department visit or hospitalisation),reduce the requirement for oral corticosteroids, and in some cases improve quality of life and asthma symptoms.Some may also improve lung function.
- Patients taking monoclonal antibody therapies still need an up-to-date written asthma action plan and to follow it when symptoms worsen.
- All the monoclonal antibody therapies currently available in Australia are generally well tolerated. Injection site reactions are among the most common adverse events. Systemic reactions, including anaphylaxis, are rare but can occur.
- Before becoming eligible for PBS subsidy for monoclonal antibody therapy treatment, patients must either have been treated by the same specialist for at least 6 months, or have been diagnosed by a multidisciplinary severe asthma clinic team.
- Identify patients with uncontrolled asthma who might benefit from monoclonal antibody therapy and offer referral for specialist assessment without delay, after checking and correcting common causes of uncontrolled asthma such as incorrect inhaler technique and suboptimal adherence.
- Arrange specialist referral for any patient for whom long-term maintenance oral corticosteroids for asthma have been prescribed or are being considered, or who requires frequent short courses of oral corticosteroids for acute asthma (if no recent specialist review).
- Advise patients who have been prescribed a monoclonal antibody therapy to keep taking their inhaled corticosteroid preventer. Continue to check adherence and inhaler technique regularly.
- Ensure that each patient has an up-to-date written asthma action plan: review it at least yearly or whenever the medication regimen is changed. Remind patients taking monoclonal antibody therapy to follow their written asthma action plan when symptoms worsen.
- Ensure that patients understand that they must attend all scheduled specialist visits in order to remain eligible for access to monoclonal antibody therapy through the PBS.
- When administering monoclonal antibody therapies, instructions for storing, preparing and administering doses should be followed carefully. The patient must be monitored under direct observation by a health professional (e.g. registered nurse or GP) for at least 30 minutes after the injection for maintenance doses.
This information paper was prepared in consultation with the following health professionals:
- Professor Connie Katelaris, allergist and clinical immunologist
- Professor Vanessa McDonald, clinical academic nurse consultant
- Professor Helen Reddel, respiratory physician
- Ms Debbie Rigby, pharmacist
- Dr Victoria Smith, general practitioner
- Professor Peter Wark, respiratory physician
Funded by an independent grant from GSK Australia. Apart from providing a financial grant, GSK Australia has not been involved in the development, recommendation, review or editing of this publication.
National Asthma Council Australia. Monoclonal antibody therapy for severe asthma. National Asthma Council Australia; Melbourne: 2018.
Although all care has been taken, this information paper is a general guide only, which is not a substitute for assessment of appropriate courses of treatment on a case-by-case basis. The National Asthma Council Australia expressly disclaims all responsibility (including for negligence) for any loss, damage or personal injury resulting from reliance on the information contained herein.