Antibiotic prescriptions increased during COVID-19, forcing us to grapple with the antimicrobial resistance pandemic in addition to the coronavirus pandemic.

Antimicrobial resistance is caused by using excessive, unnecessary antibiotics, allowing dangerous pathogens to learn to mutate and develop resistance to antibiotic therapies. The growing threat of antimicrobial resistance means there will be more and more infections that are unresponsive to even the strongest of antibiotics.

While it is well-documented that antimicrobial consumption increased in adults hospitalized with COVID-19 infection, one study, presented this week at the 40th Annual Meeting of the European Society for Pediatric Infectious Diseases (ESPID), evaluated whether this trend was consistent in pediatric populations.

The study, “Antimicrobial Prescribing in Hospitalized Children with COVID-19,” analyzed the co-infections, prevalence, and characteristics of antibiotic usage in children hospitalized with COVID-19.

This single-center, retrospective study was conducted from March 2020-December 2021. It included children (under 18 years of age) who had a positive RT-PCR SARS-CoV-2 test and were subsequently admitted to a COVID-19 referral pediatric hospital. The investigators reviewed the medical records of children for demographics and clinical characteristics, before collecting data on their antimicrobial consumption.

A total of 299 children with confirmed infection were included in the study. The median patient age was 4 years, and the cohort was 53.3% male. The children were hospitalized for an average of 5 days, and this was also the mean duration of antibiotic use. Antimicrobials were documented in 25% of patients (n = 75), and an average of 1.2 antimicrobials were prescribed per patient.

The most frequently prescribed antibiotics were penicillin (36%), cefotaxime (24%), ampicillin and gentamicin (16%), and macrolides (13.3%). Secondary bacterial infection or co-infection was reported in 26.6% of the children who received antimicrobials.

Among the children with severe COVID-19 disease, 41.3% were prescribed antibiotics for an average of 5 days. Of these children, 58.3% had abnormal chest imaging and 32% had increased C-reactive protein above 60 mg/L.

The antibiotics were either stopped or deescalated within 72 hours in 48% of patients (n = 36), without backing clinical, laboratory, or radiological evidence of bacterial infection, and 29.3% (n = 22) were neonates with fever.

The investigators concluded that of the 25% of hospitalized children prescribed antibiotics for COVID-19 infection, most received narrow spectrum antibiotics. They recommended that hospitals should determine and apply diagnostic criteria to avoid overprescribing antibodies for COVID-19.

This study, “Antimicrobial Prescribing in Hospitalized Children with COVID-19,” was presented during the 40th Annual Meeting of the European Society for Pediatric Infectious Diseases (ESPID), held online and in Athens, Greece from May 9-13, 2022.

This article originally appeared on ContagionLive.

Articles

A session at the 40th Annual Meeting of the European Society for Pediatric Infectious Diseases looks at how the pandemic impacted the used of antimicrobials.

Examining Antimicrobial Use in Children Hospitalized with COVID-19

Patients with bipolar disorder frequently receive polypharmacy, with up to 20% of patients getting 4 or more bipolar medications.

 Problematic drug-drug interactions occur often, impacting effectiveness or safety. They can be pharmacokinetic or pharmacodynamic. Yet these interactions receive little attention in the various practice guidelines and algorithms for the psychopharmacologic management of bipolar disorder. Some of these will be summarized here and in a subsequent article.

The antipsychotics that may cause weight gain—especially olanzapine, quetiapine, and clozapine—can cause even more weight gain when added to valproate.

Lithium is well known to interfere with the synthesis and release of thyroid hormones and, in the brain’s effort to compensate for this, thyroid-stimulating hormone will increase. Periodic monitoring is required. What is not so well known is that carbamazepine (CBZ) decreases T4, possibly by induction of the UGT metabolizing enzyme, which exacerbates or hastens the onset of hypothyroidism.

 Thus, the combination of lithium and CBZ may present additive risks. Quetiapine also has some evidence of causing thyroid dysfunction.

Lithium and anticonvulsants—especially valproate and CBZ—produce a metabolic-type or action tremor (ie, it is worse when doing an action like extending the arms—similar to benign familial essential tremors and tremors associated with hyperthyroidism, electrolyte abnormalities, and alcohol intoxication and withdrawal). When these medicines are used in combination, the severity or likelihood of tremor increases.

Antipsychotics—especially the older neuroleptics and risperidone/paliperidone—produce Parkinsonian tremors (resting tremors—slower than metabolic tremors, rhythmic, typically 4 to 6 beats per second).

 Lithium seems to increase antipsychotic-induced Parkinsonian tremors by a not-well-understood mechanism.

Antipsychotics that raise prolactin (eg, risperidone, paliperidone, and most first-generation antipsychotics) increase osteoporosis risk through a pharmacodynamic effect. For this reason and others, guidelines now recommend routine monitoring of prolactin change with all antipsychotics.

 Selective serotonin reuptake inhibitors (SSRIs), which are usually not recommended in bipolar patients but often used, also increase osteopenia by a different mechanism involving serotonin. With use of both agents, one can expect an additive harmful effect on bone metabolism.

CBZ also causes osteoporosis through its effect to induce the metabolism of vitamin D. Thus, the combination of CBZ with the prolactin-inducing antipsychotics or with SSRIs, or all three in combination, may produce additive bone harms over the long term.

 But here’s some good news: Lithium may protect from osteoporosis. The use of lithium in combination with antipsychotics and/or SSRIs could reduce the risk associated with the other agents. Better still: Use lithium alone for your patients with bipolar disorder if you can.

Watch out for drug-drug interactions with combinations involving ziprasidone, haloperidol, citalopram, escitalopram, quetiapine, risperidone, and lithium.

This article originally appeared on Psychiatric Times.

1. de Leon J, Spina E. Possible pharmacodynamic and pharmacokinetic drug-drug interactions that are likely to be clinically relevant and/or frequent in bipolar disorder. 

2. Osser DN. Neuroleptic induced pseudoparkinsonism. In: Joseph AB, Young RR, eds. 

Movement Disorders in Neurology and Neuropsychiatry, 2nd Edition

3. Osser DN. Prolactin monitoring in first-episode psychotic patients. 

4. Hindley G, Gall N. QT interval prolongation. In: Taylor DM, Gaughran F, Pillinger T, eds. 

The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry

Up to 20% of patients with bipolar disorder have 4 or more medications, so it is important to be aware of these common drug-drug interactions.

A Look at Drug-Drug Interactions in Patients with Bipolar Disorder

Though slightly less accurate than the genetic COVID-19 tests administered in healthcare settings, rapid antigen tests have allowed people to test for COVID-19 quickly and cheaply from home.

However, rapid antigen tests were developed and authorized using the original strain of SARS-CoV-2 that emerged in 2019. Since then, there have been several highly infectious mutations of the virus, such as the Delta and Omicron variants.

 hypothesized that the rapid tests may be less effective in detecting the emerging “variants of concern.”

The most recent variants of concern, Delta and Omicron, contain numerous amino acid mutations to the spike protein. Additionally, Delta has D63G, R203M, and D377Y nucleocapsid mutations, while Omicron has P13L, Δ31–33, R203K, and G204R nucleocapsid mutations.

The easy-to-use rapid antigen COVID-19 tests differ from sensitive molecular tests in that they do not detect multiple genes, but rather 1 genetically conserved nucleocapsid viral protein. The investigators noted that most of the rapid tests approved under Emergency Use Authorization (EUA) by the US Food and Drug Administration (FDA) feature limits of detection (LoDs) established with gamma-irradiated or heat-inactivated preparations of the USA WA1/2020 (WA1) strain, lacking the Delta and Omicron nucleocapsid mutations.

The investigators used cultured plaque-titered live Omicron, Delta, and WA1 COVID-19 strains to assess differences in the LoDs of 4 different rapid antigen tests. Using LoD, the smallest amount of viral antigen detectable with 95% certainty, they analyzed the Binax, CareStart, GenBody, and LumiraDx tests.

The study found that all tests were highly sensitive to the Omicron variant, with a 95% LoD threshold either equivocal to or lower than the original WA1 strain. However, LoDs for Delta were 40- to 140-fold higher than for WA1 in all tests but the CareStart.

“We expect that the observed loss in Delta sensitivity could have resulted in a 20% or more loss of detection in potentially infectious individuals,” said James Kirby, MD, a study author and director of the Clinical Microbiology Laboratory at the Beth Israel Deaconess Medical Center. He then pointed out, “Nevertheless, the most infectious individuals still should have been detected.”

This “true reduction in analytical sensitivity for Delta” could have implications of decreased test accuracy for any emerging or future variants of concern.

“Our findings suggest that antigen test performance needs to be reevaluated for emerging variants to ensure they still meet the intended public health testing goals of the pandemic,” Kirby said.

Stanley S, Hamel DJ, Wolf ID, et al. Limit of Detection for Rapid Antigen Testing of the SARS-CoV-2 Omicron and Delta Variants of Concern Using Live-Virus Culture. 

. 2022 Apr 20;e0014022. doi: 10.1128/jcm.00140-22. Online ahead of print.

Investigators examined whether rapid antigen tests were less sensitive to variants of concern. Though the tests detected Omicron, all but 1 were less effective in detecting the Delta variant.

Are COVID-19 Rapid Tests Capable of Detecting Variants of Concern?

A recent analysis of data from nearly 4000 patients in the US provides insight into the association of food insecurity in young adulthood with risk of diabetes later in life.

Conducted by investigators from Washington State University (WSU), data from the study suggest food insecurity was associated with increases in BMI as well as increased incidence of obesity and diabetes from young to middle adulthood in unadjusted and adjusted models.

“When we look at the data 10 years later, we do see this separation in prevalence of diabetes: those that experienced risk of food insecurity at young adulthood are more likely to have diabetes in middle adulthood,” said Cassandra Nguyen, PhD, the study’s lead author and an assistant professor with WSU’s Institute for Research and Education to Advance Community Health, in 

Citing reliance on cross-sectional studies and self-reported data among previous studies, Nguyen and a team of colleagues designed the current study as an analysis of data from the 4th and 5th waves of the National Longitudinal Study of Adolescent to Adult Health, with the intent of assessing the association of risk of food insecurity with BMI, obesity, and diabetes, with adjustment for sociodemographic features. A nationally representative cohort study conducted by the Carolina Population Center at the University of North Carolina–Chapel Hill, the study provided investigators with data related to more than 20,000 adolescent patients enrolled during the 1994-1995 academic school year.

Limiting their study to those with data from waves 4 and 5 of the study, which occurred in 2008-2009 and 2016-2018 when cohort members were 24–32 and 32–42 years old, respectively, investigators identified a cohort of 3992 individuals with no missing data related to risk of food insecurity, body weight, diabetes, and sociodemographic characteristics for inclusion in their study. Overall, 4655 patients had participated in both wave 4 and wave 5, but 663 patients were considered ineligible for inclusion based on missing data.

Results of the investigators’ analyses suggested risk of food insecurity at wave 4 was significantly associated with respondents’ sex (

=.02). Initial analysis indicated the prevalence of obesity at both wave 4 (

=.004) was higher among participants who were at risk of food insecurity at wave 4 in comparison to those not at risk of food insecurity. Additionally, the prevalence of diabetes at wave 4 was not significantly altered by risk of food insecurity at wave 4 (

=.21) but was more prevalent among participants during wave 5 who had reported risk of food insecurity at wave 4 (

In models adjusting for Further analysis revealed risk of food insecurity was no longer significantly associated with obesity among non-Hispanic White respondents (

 >.05), and interaction terms between risk of food insecurity and assessment wave were not significant in any models (

 >.05) in models adjusting for sociodemographic characteristics.

“In the current study, risk of food insecurity assessed at 1 time point in young adulthood was associated with BMI and obesity at young adulthood and middle adulthood but did not relate to change over time. This aligns with prior research that reports food insecurity is associated with higher BMI,” investigators wrote.

Nikolaus CJ, Hebert LE, Zamora-Kapoor A, Sinclair K. Risk of Food Insecurity in Young Adulthood and Longitudinal Changes in Cardiometabolic Health: Evidence from the National Longitudinal Study of Adolescent to Adult Health. 

. 2022 Mar 14;nxac055. doi: 10.1093/jn/nxac055.  Online ahead of print. 

An analysis of data from more than 3500 individuals followed for more than 20 years provides insight into the impact of food insecurity on risk of cardiometabolic conditions, including obesity and type 2 diabetes.

The Link Between Food Insecurity in Young Adulthood and Obesity, Diabetes Risk Later in Life

According to the results of a new study, individuals seeking treatment for depression with lower incomes, lower education levels, and those who identify as minorities tend to have worse outcomes even when receiving equal access to treatment.

 Jeffrey Mills, PhD, and Jeffrey Strawn, MD, led the University of Cincinnati cross-college collaborative research.

Investigators analyzed data from a large clinical trial, the Combining Medications to Enhance Depression Outcomes study, that enrolled 665 participants seeking treatment for depression. All participants had the same access to treatment without differences due to health insurance or income. The study also controlled for sex, age, and treatment type. Following 12 weeks of antidepressant medication treatment, participants who were nonwhite improved 11.3% less compared to white patients. Participants who were unemployed saw 6.6% less improvement compared to employed patients. Participants the 25th percentile of income distribution had 4.8% reduced improvement when compared to participants in the 75th percentile. Patients who were nonwhite, unemployed, without degree, and in the 25th income percentile had 26% less improvement compared to patients who were white, employed, with a college degree, and in the 75th income percentile.

“We think about these things in terms of access, we think about them in terms of income inequality, and I realize that education does track with those, but just having a college degree while controlling for all of these other factors still had a significant impact,” said Strawn, professor in the Department of Psychiatry and Behavioral Neuroscience in UC’s College of Medicine and a UC Health adolescent psychiatrist.

Strawn also noted that while the findings are still preliminary, results suggest that participants without a college degree had 9.6% less improvement compared to college graduates. Furthermore, previous research indicates that individuals seeking treatment for depression with lower income and less education have worse outcomes because of a lack of access to quality health care, but socioeconomic factors are hard to isolate.

Mills, professor of economics in UC’s Carl H. Lindner College of Business, said that the findings do not negate the fact that a lack of access makes an impact on treatment outcomes, but it does show the importance of including a patients’ home environment when analyzing the effectiveness of treatment.

“If you’re going home to a wealthy neighborhood with highly educated parents or spouse, then you’re arguably in a much better environment for the treatment to be effective than if you’re going to a poor neighborhood with other problems,” said Mills.

Strawn believes future studies should consider socioeconomic variables that may have been previously overlooked.

“When we don’t control for these variables, which we often do not in our clinical trials because of differences in populations, we may miss detecting an effective treatment because its effect is obscured,” Strawn said. “It can potentially jeopardize our treatment development by not accounting for these factors.”

Moving forward, the investigators want to combine data from other depression trials to produce more powerful results with a larger dataset.

This article originally appeared on Psychiatric Times. 

1. Mills JA, Suresh V, Chang L, et al. Socioeconomic predictors of treatment outcomes among adults with major depressive disorder. 

2. Socioeconomic factors affect response to depression treatment. News release. April 15, 2022. Accessed May 6, 2022. 

https://www.newswise.com/articles/socioeconomic-factors-affect-response-to-depression-treatment

Home environments have a clear impact on depression treatment outcomes. 

How Socioeconomic Factors Can Impact Depression Treatment

The US Food and Drug Administration (FDA) has granted approval to tirzepatide (Mounjaro) as an adjunct therapy to diet and exercise for improving glycemic control in adults with type 2 diabetes, according to a 

Announced on May 13, approval of the first-in-class, once-weekly dual GLP-1/GIP agonist, which is expected to be available in 5 mg, 10 mg, and 15 mg doses, is based on data from the SURPASS program.

“Given the challenges many patients experience in achieving their target blood sugar goals, today’s approval of Mounjaro is an important advance in the treatment of type 2 diabetes,” said Patrick Archdeacon, MD, associate director of the Division of Diabetes, Lipid Disorders, and Obesity in the FDA’s Center for Drug Evaluation and Research, in the FDA’s announcement.

In the SURPASS program, tirzepatide’s ability to improve glycemic control as a stand-alone agent or adjunct therapyin 5 trials comparing the agent against placebo therapy and other diabetes medications, including semaglutide and 2 long-acting insulin analogs.

In these trials, patients receiving 15 mg tirzepatide experienced a mean HbA1c reduction that was 1.6% greater than those observed with placebo when used as a stand-alone therapy and 1.5% greater than placebo therapy when used in combination with a long-acting insulin. In the trials comparing tirzepatide 15 mg against other diabetes medications, results suggested those receiving tirzepatide had an HbA1c reduction 0.5% greater than semaglutide, 0.9% more than insulin degludec, and 1.0% more than insulin glargine.

In their release, the FDA also touched upon tirzepatide’s effects on obesity and body weight. In the SURPASS program, those randomized to tirzepatide 15 mg had a mean weight loss Han was 15 pounds greater than that observed with placebo when neither were used with insulin and 23 pounds more than placebo when both were used with insulin. In trials comparing tirzepatide to other agents, use of tirzepatide was associated with weight loss that was 12 pounds greater than was observed semaglutide, 29 pounds greater than insulin degludec, and 27 greater than insulin glargine.

“Collectively, the SURPASS study results exceeded our expectations and point toward tirzepatide’s efficacy in people living with type 2 diabetes at different stages of their treatment journeys,” said Laura Fernández Landó, MD, Senior Medical Director of tirzepatide for type 2 diabetes at Eli Lilly and Company, in a statement related to the company’s presentation at ADA 2021. “Tirzepatide is delivering unprecedented results that could help millions of people with type 2 diabetes and their health care providers reach A1C and weight goals—both key measures of diabetes management.”

In their release, the FDA noted commonly reported adverse events with tirzepatide included nausea, vomiting, diarrhea, decreased appetite, constipation, upper abdominal discomfort, and abdominal pain. The FDA also noted tirzepatide caused thyroid C-cell tumors in rates but it is not known whether it causes such tumors in humans and should not be used in those with a personal or family history of medullary thyroid cancer or in patients with Multiple Endocrine Neoplasia syndrome type 2. Additionally, the agent has not been studied in patients with a history of pancreas inflammation and is not indicated for use in patients with type 1 diabetes.

This article was originally published by Endocrinology Network.

Announced on May 13, the approval indicates Eli Lilly and Company's novel dual GLP-1/GIP agonist, tirzepatide (Mounjaro), for use as an adjunct to diet and exercise to improve blood sugar in adult patients with type 2 diabetes.

FDA Approves Tirzepatide (Mounjaro) for Type 2 Diabetes

While only 5% of older adults lacked prescription drug coverage in 2021 – down from 32% in 1998 – 20% reported financial hardship from prescription drug purchases, according to a study.

Those without prescription drug insurance, requiring multiple daily medications, and reporting a low annual household income struggled the most. Even those with insurance from lower income households still struggled when needing multiple daily medications.

The researchers said that among older adults in the United States, policies that reduce the out-of-pocket expenditures for prescription drugs appeared to reduce the burden of these expenditures, and suggest that managed care policymakers should consider policies that reduce out-of-pocket costs for older adults in an effort to promote medication access. Such policies may enable older adults to reallocate funds for vital expenses like food and shelter, especially for older adults from vulnerable populations.

The report states that the inability to pay for prescription drugs is an important determinant of medication adherence that may lead patients to ration or split doses, delay refills or new prescriptions, and even stop taking medications altogether. Cost-related nonadherence compromises the therapeutic effectiveness in managing most chronic diseases, persists even when patients cut back on basic health-related social needs, and consequently leads to higher preventable health care expenditures.

The data were from four nationally distributed, cross-sectional surveys of older adults to track coverage for and financial hardship from purchasing prescription drugs.

This article originally appeared on Medical Economics.

Olson A, Schommer JC, Mott DA, Adekunle O, Brown LM. Financial hardship from purchasing prescription drugs among older adults in the United States before, during, and after the Medicare Part D “Donut Hole”: Findings from 1998, 2001, 2015, and 2021. 

. 2022 May;28(5):508-517. doi: 10.18553/jmcp.2022.28.5.508. 

Lower household income and requiring multiple medications play large roles

Prescription Drug Insurance Out of Reach for Many Older Adults

A new report suggests patients who complete inpatient rehabilitation for chronic obstructive pulmonary disease (COPD) have better outcomes when they use a digital therapeutic app to continue their rehabilitation at home.

In the study conducted by physicians at Zurich Rehabilitation Centers in Switzerland and the University of Marburg in Germany patients were tracked for 6 months following their release from rehabilitation. Half of the 60 patients were asked to use 

 to assist their rehabilitation. The app includes a training program, breathing and relaxation exercises, and patient education resources. The other half (30 patients) acted as a control group, receiving only standard follow-up care. Patients were assessed by an activity tracker to see how the app affected their physical activity and recovery.

The data showed patients who used the app had increased physical activity compared to the control group. It also showed that app users had improved scores on the COPD Assessment Test, in which patients rate symptoms such as coughing, congestion, and chest tightness.

Nigel Ohrenstein, M.A., Kaia Health’s president, said the study is important because it shows that app-directed COPD rehabilitation can be successful at home. He said that is particularly meaningful for patients in suburban and rural areas who may have to drive significant distances to access their closest pulmonary rehabilitation center.

“By offering Kaia COPD to patients we hope to improve access to this care modality, lower the barrier to integrating exercise into the patients’ lives, and provide a training program that helps maintain physical activity levels,” he told 

, adding that maintaining physical activity has been linked with better survival rates in patients with COPD.

In addition to relieving the travel burden of in-person rehabilitation, the company said the app relieves the mental burden of trying to remember all of the information and exercises learners in the clinic and putting them into practice at home.

Ohrenstein said the app allows patients to complete exercises without the help of a medical provider and without the need for additional training because the training is built into the app itself. The version of the app used in the study provided pre-recorded videos to help patients learn and complete the exercises, but he said the current version of the app includes technology that can assess patients’ exercise technique using a user’s smartphone or tablet camera.

“Computer vision and our proprietary AI algorithms can analyze movements in real-time to evaluate performance and give audiovisual feedback to guide users through their physical training,” he said.

The theory is that by ensuring patients are doing the exercises properly, the app will boost the impact of the exercises.

The patients in the study were all considered to have moderate-to-high severity COPD, and Ohrenstein said the improvement shown in the study was consistent across several subgroups.

This article originally appeared on Managed Healthcare Executive.

Spielmanns M, Gloeckl R, Jarosch I, et al. Using a Smartphone Application Maintains Physical Activity Following Pulmonary Rehabilitation in Patients with COPD: A Randomised Controlled Trial. 

. 2022 Apr 21;thoraxjnl-2021-218338. doi: 10.1136/thoraxjnl-2021-218338.  Online ahead of print. 

Data suggest a smartphone application can boost physical activity and relieve symptoms of chronic obstructive pulmonary disease.

At-Home Outcomes Following Inpatient Rehabilitation for COPD Improved by Rehabilitation App

Lauren Biscaldi is the Managing Editor of Drug Topics. 

Home environments have a clear impact on depression treatment outcomes.

Many Biologics for Severe Asthma Can Be Self-Administered at Home — Patients Prefer It

Xolair (omalizumab), Fasenra (benralizumab), Dupixent (dupilumab) and Nucala (mepolizumab) can now be self-administered.

Your weekly roundup of the latest news from Drug Topics®.

News Roundup: May 9 to May 13

Patients with severe asthma are often burdened with frequent exacerbations requiring numerous visits to clinics and doctors’ offices for symptom monitoring and treatment evaluation. New severe asthma treatments, specifically biologics, have helped manage severe asthma symptoms and decrease the frequency of exacerbations. In this respect, they have helped improve patients’ quality of life. However, many patients using biologics for severe asthma must receive treatment from a healthcare professional at a clinic or doctor’s office. This may involve making a trip to a healthcare facility at least every 4 weeks for treatment administration.

Biologics currently FDA-approved to treat severe asthma are all injectables. However, four of the six approved agents are now available in formulations that can be self-administered at home with training from a healthcare provider. Genentech’s Xolair (omalizumab) is available as a prefilled syringe for subcutaneous self-injection in patients 12 years or older with severe allergic asthma. A caregiver may administer Xolair at home to children ages 6 to 11 years.

AstraZeneca’s Fasenra Pen (benralizumab) is a prefilled autoinjector for subcutaneous self-injection in patients ages 12 years or older with severe eosinophilic asthma.

Dupixent (dupilumab), made by Regeneron and Sanofi, is available as a prefilled pen and a prefilled syringe that can be self-administered subcutaneously in patients 12 years and older with moderate to severe eosinophilic asthma. Caregivers may administer Dupixent prefilled syringes to children ages 6 to 11 years.

And in January of this year, the FDA approved a prefilled autoinjector and a prefilled pen for self-injection for GlaxoSmithKline’s Nucala (mepolizumab). Both forms are approved for subcutaneous self-injection in patients 12 years or older with severe eosinophilic asthma. Caregivers may administer Nucala to children ages 6 to 11 years with approval from a healthcare professional.

 found that most patients with severe asthma preferred and felt safe self-injecting biologics at home to treat their asthma. The study, conducted in northeast Italy, surveyed 180 patients who were undergoing regular treatment for severe asthma and were using one of the following biologics: mepolizumab, omalizumab, benralizumab, or dupilumab.

After receiving self-administration instructions from a healthcare professional, 93% of participants reported that it was easy to self-administer their medication. Of these, 52% considered the process extremely easy, and 94% felt safe while self-injecting the biologic. Mild side effects were reported by 22% of patients within 2 to 3 days of self-administration. Of all participants, 97% said they would recommend self-administration of biologic treatment for severe asthma.