Dupilumab Proven Effective in Treating Patients With Severe Asthma, Study Finds

A study on the efficacy of the biologic drug, dupilumab, found that individuals with severe type 2 asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) saw improvement of asthma exacerbations and breathing quality after receiving the treatment.

“The aim of our present real-life observational investigation was to evaluate the therapeutic impact of dupilumab on upper and lower airway symptoms, severe asthma exacerbations, OCS [oral corticosteroids] intake and lung function, as well as on the overall clinical expression of nasal polyposis,” wrote the researchers of this study.

The results of this retrospective multicenter cohort study were published in Frontiers in Immunology.

To evaluate the efficacy of dupilumab in daily practice, the researchers examined the number of asthma exacerbations, emergency department (ED) visits, and daily use of inhalations of short-acting β₂-adrenergic agonists. The researchers also aimed to confirm that patients experienced therapeutic responses to dupilumab using a skin prick test (SPT) and the presence of absence of CRSwNP.

Other primary outcome factors included:

• Prednisone intake
• Asthma control test (ACT) score
• Sino-nasal outcome test questionnaire (SNOT-22)
• Number of relapses of nasal polyposis
• Forced expiratory volume per 1 second (FEV₁), forced vital capacity (FVC), and mean forced expiratory flow between 25% and 75% of FVC
• Fractional exhaled nitric oxide (FeNO) levels
• Blood eosinophil, basophil, and neutrophil counts

A total of 127 patients with severe asthma were recruited to receive dupilumab injections over 24 weeks. Of these patients, 90 had positive SPT and 78 reported CRSwNP.

Compared with the 6 months preceding the patient’s first dupilumab injection, the study showed that median (IQR) asthma exacerbations decreased from 4.0 (2.0-5.0) to 0.0 (0.0-0.0) (P < .001), in addition to daily prednisone intake, which fell from 12.40 (0.00-25.00) to 0.0 (0.00-0.00) mg (P < .001).

Furthermore, ACT score increased from 14 (10-18) to 22 (20-24) (P < .0001), and mean (SD) SNOT-22 score dropped from 55.84 (20.32) to 19.76 (12.76) (P < .0001).vFEV₁ increased from 2.13 L (1.62-2.81) at baseline to 2.39 L (1.89-3.06) (P < .0001) after 6 months. FeNO values decreased from 27 (18.0-37.5) to 13 (5.0-20.0) ppb (P < .0001).

The improvements observed were similar in patients with and without CRSwnP.

Lastly, no significant correlations were found between serum immunoglobin E (IgE) levels, baseline blood eosinophils, or FeNo levels, and dupilumab-induced changes, other than FEV₁ increase, which was positively associated with FeNo values (r = 0.3147; P < .01).

From these findings, the study authors determined that treatment with dupilumab was successfully able to clear asthma exacerbations in the 6 months of treatment, as well as prevent EDvisits, bronchodilator use, and the intake of OCS.

“Our results consolidate the strategic position of dupilumab in its role as an excellent therapeutic option currently available within the context of modern biological treatments of severe asthma and CRSwNP, frequently driven by type 2 airway inflammation,” concluded the researchers.

Reference

Pelaia C, Benfante A, Busceti MT, et al. Real-life effects of dupilumab in patients with severe type 2 asthma, according to atopic trait and presence of chronic rhinosinusitis with nasal polyps. Frontiers in Immunology. Published online March 30, 2023. doi:10.3389/fimmu.2023.1121237