Dr Neal Jain Explains How Dupilumab Differentiated Itself as a Late Entrant to the Asthma Market

Even though dupilumab was a late entrant to the market to treat asthma, its efficacy “speaks for itself,” said Neal Jain, MD, FAAP, FAAAAI, director of research at Arizona Allergy & Immunology Research and a co-owner of Arcadia Allergy & Asthma and San Tan Allergy & Asthma.

Transcript

Dupilumab was a late entrant onto the market to treat asthma—how has it managed to differentiate itself?

Despite the fact that it was a late entrant into the market, it has really sort of been an important option for those of us that have patients that have very severe disease and especially those that have comorbid disease, including those that have comorbid nasal polyposis or certainly atopic dermatitis.

And so, I think that, you know, despite the fact that it was late, its efficacy, you know, speaks for itself. It's one of the most efficacious of the biologics that we use for severe asthma, especially in comparison to I think the first-generation biologic, which was really Xolair. You know, if you were to try to compare the 2, we have many patients who have failed other therapies, including Xolair and subsequently other therapies that target [interleukin] IL-5. And dupilumab has really been a nice option for those individuals that have failed those therapies or have comorbid disease.

How much market penetration has there been for dupilumab? What barriers have there been to its uptake?

I think there's been a significant amount of market penetration. I think it's variable depending upon what group of individuals you look at. So, you know, I think certainly amongst allergists, and those of us that see the importance of type 2 inflammation in the pathology of asthma, it's been an important option.

I think there's been a little bit of a slower uptake, and in part because of, I think, marketing, relating to the importance of eosinophils and the knowledge about eosinophils that pulmonologists have. And so, I think it's a little bit more simplistic for them to think about eosinophils than it is to think about type 2 inflammation. As a result of that. I think I see them really using the anti–IL-5 agents a little bit more than they are using dupilumab.

But I think again, as we see patients that have comorbid nasal Polyps that have ultra-severe disease, or who are having a suboptimal response to one of the anti–IL-5 agents, they're, I think, becoming more accustomed to using dupilumab. Not to say that it should be pegged as a medicine that's only used in people who have failed other therapies. But I think that's sort of the entry point for them as they start to say, “Oh, well, I've seen people fail on this, and then I've seen them succeed with this.” I think as that happens, they will become more apt to use it earlier, as a therapeutic option when they have their patients that have severe disease, whether it be you know, just severe disease or even oral steroid-dependent asthma.