Dr William “Andy” Nish Details List of Drugs Targeting Asthma Biomarkers

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William “Andy” Nish, MD, is Medical Director and Specialist Allergy and Immunology Provider at the Northeast Georgia Physicians Group in Gainesville, Georgia.

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Is it possible to use predictive biomarkers to identify the most effective therapies for patients?

Yes. In fact, in order to pitch someone on a biologic, we have to use certain biomarkers to qualify them. So, for example, there are sort of 3 categories of organic products, if you will. The first being Xolair, or omalizumab. And for this they must have a certain IgE [immunoglobulin E] level. Now the bar is a little low, it’s 30 [KU/L]. So that’s not a lot of IgE. They must be 30 [KU/L], and then they must also be allergic to a perennial allergen, either by skin test or by RAST [radioallergosorbent test]. So, this is for Xolair.

Then there are 3 biologics that are anti-IL5 [interleuken-5], and that includes Nucala, or mepolizumab, and Fasenra, or benralizumab, then Cinqair, which is reslizumab. So for Nucala and Fasenra you must have at least about 200 eosinophils, then for Cinqair, reslizumab, based on their pivotal trials, you must have over 400. [eosinophils]. These are the anti-IL-5s.

And so, just a linkage here: if we’re talking about type 2 inflammation, or TH-2 inflammation, then we’re talking about IL-4, IL-5, and IL-13. They are the ones that really cause this type 2 inflammation. They drive it through eosinophils and thus help increase the number and differentiation of eosinophils. So the 3 we mentioned are anti-IL-5, then Dupixent, or dupilumab, is actually anti-IL-4 and IL-13. So these are the kind of 3 categories that we have in terms of how it works.


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