Michael E. Wechsler, MD, and Flavia C.L. Hoyte, MD, prepared useful practice aids pertaining to uncontrolled persistent asthma for this CME activity titled "Advances in the Treatment of Uncontrolled Persistent Asthma: Expert Insights in Personalizing Patient Care.” For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2YSAn7u. CME credit will be available until July 24, 2020.

1. Access the activity, “Advances in the Treatment of Uncontrolled Persistent Asthma:
Expert Insights in Personalizing Patient Care,” at PeerView.com/PBN40.
Guide to Selecting Biologic Therapy
for Patients With Uncontrolled Asthma
PRACTICE AID
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Other factors influencing treatment decisions
• Patient comfort with a newer versus older agent
• Patient comfort with self-administration
• Injection frequency
• Comorbid conditions
Head-to-head
studies needed
Selecting Treatment for Uncontrolled Asthma
Anti-IgE Versus Anti‒IL-5 Versus Anti‒IL-4Rα1,2
Anti-IgE anti–IL-5,
or anti–IL-4Rα
Anti–IL-5
or anti–IL-4Rα
Anti–IL-4Rα
Allergic non-eosinophilic asthma
Allergic eosinophilic asthma
Eosinophilic asthma and
• Nonallergic
• Allergic but with IgE out of dosing range
for anti-IgE treatment
Asthma that is dependent
on oral corticosteroids
Anti-IgE

2. Access the activity, “Advances in the Treatment of Uncontrolled Persistent Asthma:
Expert Insights in Personalizing Patient Care,” at PeerView.com/PBN40.
Guide to Selecting Biologic Therapy
for Patients With Uncontrolled Asthma
PRACTICE AID
CRTh2: chemoattractant receptor-homologous molecule expressed on T-helper 2 cells; IgE: immunoglobulin E; IL: interleukin; IL-#R: interleukin-# receptor; TSLP: thymic stromal lymphopoietin.
1. Papathanassiou E et al. Eur Clin Resp J. 2016;3:31813. 2. Magnan A et al. Allergy. 2016;71:1335-1344. 3. Xolair (omalizumab) Prescribing Information. https://www.gene.com/download/pdf/xolair_
prescribing.pdf. Accessed June 10, 2019. 4. Nucala (mepolizumab) Prescribing Information. http://www.accessdata.fda.gov/drugsatfda_docs/label/2015/125526Orig1s000Lbl.pdf. Accessed June
10, 2019. 5. Cinqair (reslizumab) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/761033lbl.pdf. Accessed June 10, 2019. 6. Fasenra (benralizumab) Prescribing
Information. https://www.azpicentral.com/fasenra/fasenra_pi.pdf#page=1. Accessed June 10, 2019. 7. Dupixent (dupilumab) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_
docs/label/2017/761055lbl.pdf. Accessed June 10, 2019. 8. https://www.prnewswire.com/news-releases/
tezepelumab-granted-breakthrough-therapy-designation-by-us-fda-for-the-treatment-of-patients-with-severe-asthma-without-an-eosinophilic-phenotype-300708680.html. Accessed June 10, 2019.
9. https://clinicaltrials.gov/ct2/show/NCT03347279. Accessed June 10, 2019. 10. https://clinicaltrials.gov/ct2/show/NCT03406078. Accessed June 10, 2019. 11. Corren J et al. N Engl J Med. 2017;377:936-
946. 12. https://clinicaltrials.gov/ct2/show/NCT02563067. Accessed June 10, 2019. 13. https://clinicaltrials.gov/ct2/show/NCT03052517. Accessed June 10, 2019. 14. https://clinicaltrials.gov/ct2/show/
NCT02555683. Accessed June 10, 2019.
Agent/Target Indication/Current Status Route/Dosing
Patients aged ≥6 y with moderate to
severe persistent allergic asthma
inadequately controlled with
inhaled corticosteroids
Subcutaneous
75-375 mg every 2-4 weeks
(dosage based on IgE level
and body weight)
Add-on maintenance treatment of
patients aged ≥12 y with severe asthma
and an eosinophilic phenotype
Subcutaneous
100 mg every 4 weeks
Add-on maintenance treatment of
patients aged ≥18 y with severe asthma
and an eosinophilic phenotype
Intravenous infusion
3 mg/kg every 4 weeks over
20-50 minutes
Add-on maintenance treatment of
patients aged ≥12 y with severe asthma
and an eosinophilic phenotype
Subcutaneous
30 mg every 4 weeks for first
3 doses, then every 8 weeks
Add-on maintenance treatment of
patients aged ≥12 years with moderate
to severe asthma with an eosinophilic
phenotype or with oral
corticosteroid-dependent asthma
Subcutaneous
Initial dose of 400 mg followed by 200 mg
every 2 weeks or initial dose of 600 mg
followed by 300 mg every 2 weeks
Phase 3 trials; breakthrough
designation for
noneosinophilic phenotype
Subcutaneous
210 mg every 4 weeks
Phase 3 trials Oral
Dupilumab7
IL-4Rα
(IL-4/IL-13)
Tezepelumab8-10
TSLP
Fevipiprant11-14
CRTh2
Investigational
Omalizumab3
IgE
Mepolizumab4
IL-5
Reslizumab5
IL-5
Benralizumab6
IL-5Rα/βc
Approved

3. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
What Is Eosinophilic Asthma?1
1. https://www.everydayhealth.com/hs/asthma/eosinophilic-asthma-essential-facts/. Accessed June 10, 2019. 2. Eng SS et al. Clin Rev Allergy Immunol. 2016;50:140-158.
PRACTICE AID
Access the activity, “Advances in the Treatment of Uncontrolled Persistent Asthma: Expert Insights in
Personalizing Patient Care,” at PeerView.com/PBN40.
Eosinophils play an important role in your immune system
• Eosinophils are part of your immune system and may play a critical role in your body’s defense against bacterial, viral, fungal, and parasitic infections2
• They help promote inflammation, your body’s protective response to injury and infection, but too many can cause excess inflammation and swelling
• Elevated levels of eosinophils have been associated with asthma and other conditions, such as atopic dermatitis
Eosinophilic asthma often develops in adults
• Individuals who develop severe asthma in adulthood are more likely to have the eosinophilic type
• The condition is most commonly diagnosed in adults aged 35 to 50 years
Up to half of severe asthma cases may be associated with eosinophils
• About 50% of people with severe asthma may have elevated levels of eosinophils in their blood and lungs
• Your asthma may be considered severe if
– Your symptoms interfere with daily activities
– You use your rescue inhaler frequently
– Your symptoms don’t respond to typical asthma treatments taken regularly and correctly
A blood test can help diagnose eosinophilic asthma
• If you are having trouble controlling asthma symptoms despite following your treatment plan, talk to your doctor about getting tested for eosinophilic asthma
• A simple blood test called eosinophil count can help diagnose eosinophilic asthma; your doctor may also recommend a sputum eosinophil count or a
bronchial biopsy to help confirm diagnosis
Eosinophilic asthma is associated with nasal polyps
• People with eosinophilic asthma may have an increased risk of nasal polyps, or noncancerous growths, inside the nose
New medications are available to treat eosinophilic asthma
• Standard treatments for asthma include long-term controller medications and rescue medications that you use when your symptoms flare up
• If these medications are not enough to control your asthma, your doctor may prescribe newer medications called biologics that target specific molecules
involved in the action of eosinophils to help lower eosinophil levels and reduce inflammation; talk to your doctor about the treatment that’s right for you