Choosing an IL-5 Inhibitor for Asthma: Evidence, Comorbidities, Convenience

In "Choosing an IL-5 Inhibitor for Asthma: Evidence, Comorbidities, Convenience," the panel lays out how evidence, comorbidities, and daily-life logistics combine in selecting an IL-5 agent.

Dr. Chupp describes a 3-step approach to selecting an IL-5 inhibitor. First, he follows the evidence and approved indications as closely as possible. He stays within indications for the vast majority of patients.

Second, he considers the patient's disease variants and comorbidities. These agents are used in eosinophilic granulomatosis with polyangiitis, hypereosinophilic syndrome, and chronic rhinosinusitis with nasal polyps. Where data and indications overlap, he favors those drugs. Third comes shared decision-making about practical features. When 2 drugs are approved for a situation, patients generally prefer less frequent dosing. Dr. Bernstein asks whether he discusses the evidence with patients, and Dr. Chupp confirms he does, at an appropriate level.

Dr. Wechsler addresses dosing schedules and site of care. Frequent administration can be a real barrier. He describes older patients who must drive long distances for monthly injections. He has also given ultra-long-acting therapy to students studying abroad for a semester and to busy young professionals who cannot take time off work.

Patients appreciate this practically and psychologically. With injections every 2 or 4 weeks, patients think about their disease constantly. Twice-yearly dosing can align with routine follow-up: see us, get the shot, see you in 6 months.

Dr. Bernstein suggests a profile may emerge of patients less suited to monthly injections. Dr. Wechsler believes most patients will benefit from an ultra-long-acting strategy, given less frequent dosing and less disruption to daily life.

Dr. Mosnaim adds that this approach fits well with GINA guidelines and patients' lifestyles. At each 6-month visit she performs spirometry, fractional exhaled nitric oxide testing, and the Asthma Control Test. Patients avoid the uncertainty of specialty pharmacy deliveries because her office keeps the drug on site. The schedule motivates patients to keep appointments and allows directly observed therapy with tracking of biomarkers and spirometry.

Our next episode, "Ultra-Long-Acting IL-5 Inhibition: A Paradigm Shift in Asthma Care," features Dr. Mosnaim and Dr. Chupp explaining what sets the newest IL-5 option apart and why the shift in dosing matters.