ATS GUIDELINES Bundle

Treatment Table 2. Monoclonal Antibodies for Severe Asthma Agent Indication Dosing Anti-IL-5 Mepolizumab Nucala Add-on maintenance treatment of patients with severe asthma age ≥6 years, and with an eosinophilic phenotype. Age ≥12: 100 mg subcut Q4W Age 6–11: 40 mg subcut Q4W Reslizumab Cinqair Add-on maintenance treatment of patients with severe asthma age ≥18 years, and with an eosinophilic phenotype. Age ≥18: 3 mg/kg Q4W by intravenous infusion over 20–50 minutes by a healthcare professional prepared to manage anaphylaxis Anti-IL-5Rα Benralizumab Fasenra Add-on maintenance treatment of patients with severe asthma age ≥12 years, and with an eosinophilic phenotype. Age ≥12: 30 mg Q4W for the first 3 doses, followed by Q8W thereaer Anti-IL-4Rα Dupilumab Dupixent • For the treatment of patients age ≥12 years with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. (Dupixent can be used with or without topical corticosteroids.) • As an add-on maintenance treatment in patients with moderate-to-severe asthma age ≥12 years with an eosinophilic phenotype or with oral corticosteroid-dependent asthma. • An initial dose of 400 mg (two 200 mg injections) followed by 200 mg given every other week OR • An initial dose of 600 mg (two 300 mg injections) followed by 300 mg given every other week (For patients requiring concomitant oral corticosteroids or with co-morbid moderate-to- severe atopic dermatitis for which Dupixent is indicated, start with an initial dose of 600 mg followed by 300 mg given every other week.) Anti- FcεRI (anti-IgE) Omalizumab Xolair Moderate to severe persistent asthma in patients age ≥6 years of age with a positive skin test or in vitro reactivity to a perennial aeroallergen and symptoms that are inadequately controlled with inhaled corticosteroids. Age ≥6: 75–375 mg subcut Q2–4W. Determine dose (mg ) and dosing frequency by serum total IgE level (IU/mL), measured before the start of treatment, and body weight (kg ). (See the dose determination charts.) Warning: Anaphylaxis Warning: Anaphylaxis

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