Dupilumab improves asthma control and lung function in patients with insufficient outcome during previous antibody therapy

Science and Research

BACKGROUND: Biological treatments directed against IgE and IL5 have largely improved outcomes for patients with severe type-2 high asthma. However, a fraction of severe asthmatics shows insufficient treatment outcome under anti-IgE and anti-IL5/anti-IL5 receptor α (anti-IL5Rα) antibodies. OBJECTIVE: To evaluate whether switching to dupilumab was of benefit in patients with insufficient outcome under previous anti-IgE or anti-IL5/IL5Rα therapy. METHODS: We retrospectively analyzed 38 patients that were switched to dupilumab from a previous anti-IgE or anti-IL5/IL5Rα medication due to insufficient outcome. We defined response criteria after 3-6 months as an improvement in at least one of the following criteria without deterioration in the other criteria, comparing values under dupilumab to values under previous antibody: 1.increase in asthma control test (ACT) ≥ 3, 2.reduction in oral corticosteroid (OCS) dose≥50%, 3.FEV1 improvement≥150ml, and classified patients in responders and non-responders. RESULTS: Switch to dupilumab led to a response in 76% of patients. In the total cohort, ACT score increased by a mean of 2.9 (p<0.0001), while exacerbations decreased significantly (p<0.0001) and number of OCS dependent patients decreased from 15 to 12. Mean FEV1 improved of 305ml (p<0.0001). Median FeNO decreased by -30ppb (p<0.0001), while eosinophil counts increased by 0.17G/l (p<0.01). There were no significant differences in clinical characteristics between responders and non-responders to dupilumab. However, patients with increased FeNO (≥25ppb) during previous antibody were more often responders than patients with low FeNO (<25ppb) (p<0.05). CONCLUSIONS: Altogether, we show that a switch to dupilumab in patients with insufficient outcome under previous biological therapy was effective in the majority of patients.