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Mepolizumab

Reviewed on 2/25/2020

Brand Name and Other Names: Nucala

Generic Name: Mepolizumab

Drug Class: Interleukin Inhibitors; Monoclonal Antibodies, Anti-asthmatics

What Is Mepolizumab Used For and How Does it Work?

Mepolizumab is used for add-on maintenance treatment of patients with eosinophilic phenotype asthma and for adults with eosinophilic granulomatosis with polyangiitis (EGPA).

Mepolizumab is available under the following different brand names: Nucala.

Dosages of Mepolizumab:

Adult and Pediatric Dosage Forms and Strengths

Injection, Lyophilized Powder for Reconstitution

  • 100mg/vial

Injection, Solution

  • 100mg/mL
  • Available as single-dose prefilled autoinjector or syringe

Dosage Considerations – Should be Given as Follows:

Severe Asthma

  • Add-on maintenance treatment of patients with eosinophilic phenotype
  • Adults and children 12 years and older: 100 mg subcutaneously (SC) every 4 weeks
  • Children 6-11 years: 40 mg SC every 4 weeks
  • Children under 6 years: Safety and efficacy not established

Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome)

  • Indicated for adults with eosinophilic granulomatosis with polyangiitis (EGPA)
  • 300 mg SC every 4 weeks (i.e., as 3 separate 100-mg SC injections)

Dosage Modifications

Renal Impairment

  • No dosage adjustment provided in the manufacturer's labeling; dosage adjustment may not be necessary; drug is not renally eliminated

Hepatic impairment

  • No dosage adjustment provided in the manufacturer's labeling; dosage adjustment may not be necessary; drug is degraded by proteolytic enzymes, which are not restricted to hepatic tissue

Dosing Considerations

Limitations of use

  • Not for relief of acute bronchospasm or status asthmaticus
  • Not for treatment of other eosinophilic conditions

SLIDESHOW

What Is Asthma? Symptoms, Causes, and Treatments See Slideshow

What Are Side Effects Associated with Using Mepolizumab?

Common side effects of mepolizumab include:

Other side effects of mepolizumab include:

Postmarketing side effects of mepolizumab reported include:

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Mepolizumab?

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Mepolizumab has no listed severe interactions with other drugs.

Mepolizumab has no listed serious interactions with other drugs.

Mepolizumab has no listed moderate interactions with other drugs.

Mepolizumab has no listed mild interactions with other drugs.

What Are Warnings and Precautions for Mepolizumab?

Warnings

This medication contains mepolizumab. Do not take Nucala if you are allergic to mepolizumab or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

  • Hypersensitivity

Effects of Drug Abuse

  • No information available.

Short-Term Effects

  • See "What Are Side Effects Associated with Using Mepolizumab?"

Long-Term Effects

  • See "What Are Side Effects Associated with Using Mepolizumab?"

Cautions

  • Hypersensitivity reactions (e.g., angioedema, bronchospasm, low blood pressure, hives, rash) reported; these reactions generally occur within hours of administration, but in some instances can have a delayed onset (i.e., days); discontinue drug in the event of a hypersensitivity reaction
  • Not for treatment of acute asthma symptoms or acute exacerbations; do not use to treat acute bronchospasm or status asthmaticus; instruct patients to seek immediate medical advice if their asthma remains uncontrolled or worsens after initiating mepolizumab
  • In clinical trials, 2 serious adverse reactions of herpes zoster occurred during treatment compared with none in placebo; consider varicella vaccination if medically appropriate before initiating treatment
  • Do not discontinue systemic or inhaled corticosteroids abruptly upon initiation mepolizumab; reductions in corticosteroid dose, if appropriate, should be gradual and performed under the direct supervision of a physician; reduction in corticosteroid dose may be associated with systemic withdrawal symptoms and/or unmask conditions previously suppressed by systemic corticosteroid therapy
  • Eosinophils may be involved in the immunological response to some helminth infections; patients with known parasitic infections were excluded from participation in clinical trials; treat patients with preexisting helminth infection before initiating mepolizumab; if helminth infection occurs while receiving mepolizumab that does not respond to treatment, discontinue mepolizumab until the infection resolves

Pregnancy and Lactation

Data on pregnancy exposure from the clinical trials are insufficient to inform on drug-associated risk of mepolizumab use during pregnancy. Monoclonal antibodies, such as mepolizumab, are transported across the placenta in a linear fashion as pregnancy progresses; therefore, potential effects on a fetus are likely to be greater during the second and third trimesters of pregnancy. Healthcare providers can enroll patients or encourage patients to enroll themselves by 1-877-311-8972 or www.mothertobaby.org/asthma.

It is unknown if mepolizumab is distributed in human breast milk. However, mepolizumab is a humanized monoclonal antibody (IgG1 kappa), and immunoglobulin G (IgG) is present in human milk in small amounts. Consider developmental and health benefits of breastfeeding along with the mother’s clinical need for mepolizumab, and any potential adverse effects on the breastfed infant from mepolizumab or from the underlying maternal condition.

QUESTION

Asthma is a chronic respiratory disease. See Answer
References
https://reference.medscape.com/drug/nucala-mepolizumab-1000034

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