Not All Biologics Compromise the Immune System

Elizabeth Millard

April 06, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The biologics used to treat conditions such as asthma, chronic hives, eczema, and sinusitis are unlike the ones used to treat autoimmune disorders, which target specific molecules in the immune system involved with inflammation.

The "biologics we use for allergy and asthma work on the allergic arm of the immune system," said Jeffrey Factor, MD, from the Connecticut Asthma & Allergy Center in West Hartford. "That means they are not in conflict with the part of the immune system fighting off infection."

These biologics have not been shown to increase the risk for COVID-19 or to increase complications related to the disease in people who do become infected with the virus, he pointed out.

Biologics were going to be the focus of the recently canceled American Academy of Allergy, Asthma and Immunology (AAAAI) 2020 Meeting. "We've never concentrated on biologics before in the meeting, so we were all looking forward to the discussions and sessions on the topic," he told Medscape Medical News.

Patients who are immunocompromised are now encouraged to use autoinjectors, if possible, said Mitchell Grayson, MD, from the Nationwide Children's Hospital in Columbus, Ohio, who was scheduled to present at the AAAAI meeting.

Grayson said he advises his patients with asthma to be diligent about ensuring that they have a rescue inhaler at home, and that it has not expired.

For COVID-19, "what increases risk is not simply having asthma, its having to come in and get an infusion," said Grayson.

For patients who are not already on biologics, this is probably not be the time to start a new treatment regimen, he pointed out. An adverse reaction could make it necessary for the patient to visit to the office or even the hospital.

Don't Try This at Home

One of the main biologics used in allergy practices is omalizumab, an anti-IgE antibody used to treat severe, persistent asthma and chronic urticaria, explained Sanjiv Sur, MD, from the Baylor College of Medicine in Houston.

It is administered subcutaneously and, because it comes with a risk for anaphylaxis, cannot be administered at home, he warned, adding that patients should be evaluated on an individual basis assess to its risk–benefit ratio.

In this time of crisis, some "patients can be switched to oral medicines to manage their urticaria so that they need not be exposed to the risk of coming to the hospital or clinic to receive their injection," said Sur. However, if a switch is not possible, patients "should continue to receive their injection to prevent losing control of their asthma."

Similarly, patients who receive biologics like subcutaneous mepolizumab and intravenous gamma globulin, which must be administered in an infusion center or doctor's office because of the risk for severe adverse effects, should continue to receive them for asthma control, he said.

But there are asthma-focused biologics that can be used at home.

Other Options

One is dupilumab, a monoclonal antibody that blocks interleukin (IL)-4 receptor alpha, which is also used to treat atopic dermatitis and chronic sinusitis. Another is benralizumab, which blocks IL-5 receptor alpha.

Fortunately, all of these biologics continue to be available during the COVID-19 pandemic and there has been no indication that a shortage will occur, said Sur.

When it comes to the up-and-coming treatments being researched, though, momentum to bring them from the lab to the market could be slowing.

"We will come back to the point of looking at new, promising biologic options, but it requires putting that exploration on hold for now," said Grayson. "All of the conversations we were going to have at the AAAAI meeting will still happen, but it's likely this pause may push us back a bit in terms of research and treatment rollouts."

American Academy of Allergy, Asthma and Immunology (AAAAI) 2020 Meeting

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