Mario Castro, MD, MPH: Optimizing Biologic Therapy for Asthma


Dr. Castro talks of the available biologic therapies that can be used to treat asthma and other respiratory disorders.

A myriad of different devices, molecules, and combinations had been offered to patients with asthma and chronic obstructive pulmonary disease to aid in the management of their condition. Over the past decade, similar advancements and opportunities have been cited in the realm of biologics.

In the September 2021 episode of Lungcast, Al Rizzo, MD, Chief Medical Officer of the American Lung Association (ALA), discusses several potential biologic therapies with Mario Castro, MD, MPH, Chief of Pulmonary, Critical Care and Sleep Medicine; Vice-Chair for Clinical and Translational Research; and Director of Rainbow Clinical and Translational Science Unit, Frontiers at the University of Kansas School of Medicine.

In their discussion, Castro categorized the biologic therapies that are currently available into 3 broad categories, which were anti-IgE, anti-IL-4 and anti-IL-5 receptors.

Omalizumab, and anti-IgE receptor, has been available for nearly 2 decades, and was approved for urticaria and nasal polyposis. The biologic can also be used to aid pediatric patients with underlying allergic asthma as they are re-enter schools and other communities.

“If they have underlying allergic asthma (and) you use omalizumab, you kind of dampen those triggers during the fall and keep them under much better control so they don't have to require steroids,” Castro said.

Castro also noted that there were more options regarding anti-IL-5 biologics, such as mepolizumab, reslizumab, and benralizumab. Currently, mepolizumab is the only biologic referenced in this category that is approved for patients aged 6 years old.

“When I think about those biologics, I think about several factors,” Castro said. “One is the level of blood eosinophil levels, I think about (a patient’s) underlying comorbidities, and I think about their age, as well, and what their preferences in terms of administration.”

Lastly, the anti-IL-4 category featured 1 biologic, dupilumab, which has been indicated for asthma, as well as atopic dermatitis and rhinosinusitis with nasal polyposis. He urged clinicians to be mindful of any comorbidities when recommending agents like dupilumab to help treat a wide variety of conditions while helping patients with an respiratory complications.

Ultimately, the intention of biologic therapy, Castro noted, was to maintain treatment and potential decrease the number of treatments a patient is on.

“My goal always is to eliminate their systemic steroid exposure first, then minimize their inhaled steroids to the lowest dose possible,” Castro said. “Also, just to decrease the amount of medications (patients) are on.”

Lungcast is a monthly respiratory health podcast series from the ALA, produced by HCPLive.

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