From the Guidelines
For a patient with severe asthma, eosinophil count of 362, normal IgE levels, RAST positivity only for cockroaches, and insurance coverage limited to Dupixent and Fasenra, I would recommend Fasenra (benralizumab) as the preferred treatment option. This recommendation is based on the patient's eosinophilic asthma profile, where Fasenra's mechanism of action targeting the IL-5 receptor and depleting eosinophils is particularly beneficial 1. The patient's modest eosinophil count of 362 cells/μL still falls within the range where anti-IL-5 therapy can be effective. Key points to consider in the management of this patient include:
- Implementing environmental controls to reduce cockroach exposure, such as regular cleaning, sealing cracks and crevices, professional extermination if needed, and removing food sources that attract cockroaches.
- Continuing standard asthma controller medications like inhaled corticosteroids and long-acting beta-agonists alongside Fasenra.
- Monitoring the patient's response to Fasenra and adjusting the treatment plan as necessary to achieve optimal asthma control. Although Dupixent (dupilumab) is also covered by insurance and targets IL-4/IL-13 pathways, Fasenra may be more appropriate given the patient's eosinophil profile and the specific allergic trigger identified 1. It is essential to note that the provided evidence primarily focuses on the management of EGPA, but the principles of targeting eosinophilic inflammation in asthma can be applied to this patient's scenario, prioritizing morbidity, mortality, and quality of life as the outcome.
From the FDA Drug Label
FASENRA is a prescription medicine used: o with other asthma medicines for the maintenance treatment of asthma in people 6 years and older whose asthma is not controlled with their current asthma medicines FASENRA helps prevent severe asthma attacks (exacerbations) and may improve your breathing.
The patient has severe asthma with an eosinophil count of 362, which is considered eosinophilic asthma. FASENRA (benralizumab) is indicated for the add-on maintenance treatment of severe asthma with an eosinophilic phenotype. Given that the patient's insurance only covers dupixent and Fasenra, and considering the patient's eosinophilic asthma, Fasenra could be a good option for this patient.
- Key points:
- Eosinophilic asthma
- Severe asthma not controlled with current medications
- Fasenra is indicated for add-on maintenance treatment of severe asthma with an eosinophilic phenotype
- Insurance coverage for Fasenra 2
From the Research
Treatment Options for Severe Eosinophilic Asthma
The patient has severe asthma with an eosinophil count of 362 and normal IgE levels, with RAST only positive for cockroaches. Given the insurance coverage for dupixent and Fasenra, the following options can be considered:
- Dupixent (dupilumab) is a biologic therapy that targets IL-4 and IL-13, which are involved in the pathogenesis of severe eosinophilic asthma 3, 4, 5.
- Fasenra (benralizumab) is another biologic therapy that targets the IL-5 receptor, reducing eosinophil counts and improving asthma control 6, 7, 5.
Efficacy and Safety of Biologic Therapies
Both dupixent and Fasenra have been shown to reduce exacerbation rates, improve lung function, and enhance quality of life in patients with severe eosinophilic asthma 5. The choice between these two options depends on various factors, including the patient's specific clinical characteristics and medical history.
Considerations for Treatment Selection
When selecting a treatment option, it is essential to consider the patient's eosinophil count, IgE levels, and RAST results, as well as their medical history and insurance coverage 3, 4. In this case, the patient's high eosinophil count and normal IgE levels, combined with the RAST results, suggest that either dupixent or Fasenra could be a suitable treatment option. However, more data on long-term safety and efficacy in specific patient populations are needed to guide treatment decisions 5.