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Dupilumab is a human monoclonal antibody that mediates improvement in the clinical outcomes of patients diagnosed with moderate-to-severe type 2 asthma, regardless of the status of allergen sensitization.

Dupilumab is defined as a human monoclonal antibody that is implicated in different type-2 anti-inflammatory diseases. The previous study demonstrated that dupilumab decreased severe asthma exacerbation and improved pre-bronchodilator forced expiratory volume in 1 second (FEV1) and asthma control in patients with moderate-to-severe asthma. 

The current study assessed dupilumab efficacy in patients with a type 2 inflammatory phenotype and in the subpopulation of type 2 asthma patients. The study concluded that dupilumab administration led to improvements in clinical outcomes and a decline in the levels of biomarkers in patients suffering from moderate-to-severe type 2 asthma, regardless of allergen sensitization. The study results are published in the Journal of Asthma and Allergy.

Baseline Characteristics of Study Participants

Of the total 1902 patients, 885 demonstrated allergic asthma and had a type 2 asthma phenotype, whereas 114 patients with a type 2 asthma phenotype did not exhibit an allergic phenotype based on total serum immunoglobulin E (IgE) levels.

Severe Asthma Exacerbation Rate and Pre-Bronchodilator FEV1

Patients with type 2 asthma demonstrated pre-bronchodilator FEV1 improvement with placebo vs. dupilumab regardless of the number of perennial aeroallergens. Such improvements were also observed in patients without an allergic phenotype. Dupilumab vs. placebo also significantly decreased severe exacerbation rates in type 2 asthma patients, with the highest reduction in patients sensitized to two allergens. 

The efficacy of dupilumab in decreasing asthma exacerbations was not influenced by the quantity of allergen sensitizations. Non-sensitized patients demonstrated a 65% reduction in asthma exacerbations with dupilumab compared to placebo.

Significant Improvement in Asthma Control Occurred With Dupilumab Treatment

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Asthma control, as measured by the 5-item Asthma Control Questionnaire (ACQ-5), improved during the treatment, with sensitization to one andtwo perennial aeroallergens being statistically significant. The quantity of allergen sensitizations had no effect on the effectiveness of dupilumab in controlling asthma. Similarly, a statistically significant improvement in asthma control was also observed in patients with an allergic phenotype.

Decreased Fractional Exhaled Nitric Oxide Levels and Total IgE Observed 

The fractional exhaled nitric oxide (FeNO) levels significantly decreased during the treatment of type 2 asthma phenotype patients regardless of the number of perennial aeroallergen sensitizations. Compared to the placebo, dupilumab also mediated a decrease in the levels of FeNO in patients without an allergic phenotype. The levels of total IgE also decreased during the treatment, regardless of the number of allergic sensitizations. A similar trend was observed in patients without an allergic phenotype.   

Sources

Corren, J., Jackson, D. J., Casale, T. B., Borish, L., Rabe, K. F., Busse, W. W., Maspero, J. F., Jackson, D. J., Daizadeh, N., Altincatal, A., Radwan, A., Khodzhayev, A., Djandji, M., Jacob-Nara, J. A., Rowe, P. J., & Deniz, Y. (2023). Dupilumab Efficacy in Patients with Uncontrolled Moderate-to-Severe Type 2 Asthma Regardless of Perennial Aeroallergen Sensitization. Journal of Asthma and Allergy, Volume 16, 249–260. https://doi.org/10.2147/jaa.s385645