Dr William "Andy" Nish Details the List of Medicines Targeting Asthma Biomarkers

There are several biomarkers that act as therapeutic targets for asthma, and plenty of medications aimed at inhibiting them, according to William "Andy" Nish, MD.

William "Andy" Nish, MD, is a medical director and provider with a specialty in allergy and immunology at Northeast Georgia Physicians Group in Gainesville, Georgia.


Is it feasible to use predictive biomarkers to identify which therapies may work best for patients?

Yes. In fact, to get somebody started on a biologic, we have to use certain biomarkers to get them qualified. So, for instance, there's sort of 3 categories of biologics, if you will. The first being Xolair, or omalizumab. And for that, they have to have a certain IgE [immunoglobulin E] level. Now, the bar is kind of low, it's 30 [KU/L]. So, that's not a whole lot of IgE. They have to have 30 [KU/L], and then they also have to be allergic to a perennial allergen, either skin testing or by RAST [radioallergosorbent test]. So, that's for Xolair.

Then, there are 3 biologics that are anti-IL5 [interleuken-5], and that includes Nucala, or mepolizumab, and Fasenra, or benralizumab, and then Cinqair, which is reslizumab. So, for Nucala and Fasenra, you have to have at least around 200 eosinophils, and then for the Cinqair, reslizumab, based on their pivotal trials, you have to have more like 400 [eosinophils]. Those are the anti–IL-5 ones.

And so, just a segue 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. Those are the ones that really drive that type 2 inflammation. They drive it by eosinophils, and so they help to increase the numbers and differentiation of eosinophils. So, those 3 we mentioned are anti-IL-5, and then Dupixent, or dupilumab, is actually anti–IL-4 and IL-13. So, those are the kind of 3 categories we have in terms of how they work.