Human monoclonal antibody reslizumab (Cinqair) blocks Interleukin 5-mediated immune responses (IL-5). It is used to treat allergic airway illnesses that are mediated by eosinophils since IL-5 is necessary for the activation, recruitment, and survival of eosinophils.

Reslizumab (Cinqair) Indications:

• Asthma:

  • In adults, it is used as an additional medication for the long-term management of severe asthma (with an eosinophilic phenotype).
  • Use restrictions: Treatment of acute severe asthma (including status asthmaticus) and other eosinophilic disorders are not recommended.

Reslizumab (Cinqair) Dose in Adults

Reslizumab (Cinqair) Dose in the treatment of Asthma:

• 3 mg/kg intravenously once every 4 weeks.

Reslizumab (Cinqair) dose in Children:

The safety and efficacy of the drug in children has not been established.

Reslizumab (Cinqair) Pregnancy Risk Category: C

• Studies on animal reproduction have not revealed any adverse effects.
• Monoclonal antibodies can cross over the placental barriers, especially when the pregnancy progresses.

Reslizumab use during breastfeeding:

• It is unknown if the drug will be excreted into breastmilk.
• Manufacturers recommend weighing the risks to the infant from drug exposure and the benefits for the mother.

Dose in Renal Disease:

• It has not been studied in kidney disease.
• The manufacturer has not provided any dose adjustments in patients with kidney disease.

Reslizumab (Cinqair) Dose in Liver disease:

• It has not been studied in liver disease.
• The manufacturer has not provided any dose adjustments in patients with liver disease.

Side Effects of Reslizumab (Cinqair):

• Immunologic:

  • Antibody development

• Neuromuscular & skeletal:

  • Increased creatine phosphokinase
  • Myalgia

• Respiratory:

  • Oropharyngeal pain

Contraindications to Reslizumab (Cinqair):

You may have severe allergic reactions to any ingredient of the drug.

Warnings and precautions

• Anaphylaxis [US Boxed Warning]

  • During or after the infusion, severe allergic reactions may occur including anaphylaxis.
  • Anaphylaxis was reported as soon as therapy was completed.
  • Allergy symptoms such as angioedema or anaphylaxis should be checked for in patients.
  • These may include shortness of breath and urticaria, facial swelling, wheezing and vomiting, hypotension and hypoxemia.
  • In severe reactions, treatment must be immediately discontinued and appropriate treatment must be given including epinephrine, glucocorticoids, and antihistamines.

• Malignancies:

  • Patients who received the drug were subject to malignancies in clinical trials.
  • But, there were no organ malignancies. Patients who experience weight loss or other symptoms should be examined for malignancy.

• Asthma

  • It is not recommended for acute treatment of severe asthma, exacerbation or status asthmaticus.
  • A proper rescue medication should be used in acute situations.
  • If you notice an increase in asthma symptoms, it is important to seek medical attention.

• Infections with Helminth

  • Because eosinophils are responsible for helminthic infection, it is unknown if reslizumab administration can reduce the body's response.
  • Preexisting helminthic infections should be treated before reslizumab therapy can be initiated.
  • If they develop an infection, patients may have to discontinue or withhold treatment.

Monitor:

Monitor pulmonary functions including peak flow rate Observe for the clinical features of anaphylaxis and hypersensitivity reactions. Monitor for the clinical features of infection such as fever.

How to administer Reslizumab (Cinqair)?

• It can be administered intravenous. The solution should be kept at room temperature.
• Use a compatible filter such as polyethersulfone, polyvinylidenefluoride (PVDF), nylon and cellulose acetate.
• To administer the diluted solution, an infusion set should be equipped with a low-protein-binding filter (pore diameter: 0.2 micron).
• Infusions should not be given with any other intravenous agents. 
• The infusion should be administered over 20 to 50 minutes, depending on the volume.
• However, intravenous pushes should be avoided.
• Normal saline should then be instilled after the infusion has ended. 
• For allergic reactions, observe the patient both during and after infusion. 

Mechanism of action of Reslizumab (Cinqair):

• Reslizumab, an antagonist of interleukin-5 (IgG4-kappa) receptors, is available as a prescription. 
• Since IL-5 is a key cytokine involved in eosinophil activation, proliferation, differentiation, survival, and activation, its suppression affects both the number of eosinophils and the ability of these cells to survive.
• Eosinophils are a key cell responsible for asthma, allergies and atopy. 
• Although the precise mode of action of reslizumab is still unknown, it might be a result of eosinophilia.

Metabolism: It is converted by proteolytic enzymes to small peptides or amino acids.

The half-life elimination is about 24 days

International Brands of Reslizumab:

• Cinqair
• Cinqaero

Reslizumab Brand Names in Pakistan:

No Brands Available in Pakistan.