Dupilumab for Atopic Dermatitis Led to Improvements in Comorbid Asthma, Other Benefits

Lisa P. van der Rijst

Credit: LinkedIn

A single year of dupilumab therapy for atopic dermatitis may lead to substantial improvement in comorbid asthma, according to new findings, along with a steep decrease in aeroallergen-specific immunoglobulin E (IgE) levels among individuals with asthma and/or allergic rhinitis.¹

These conclusions were drawn from new research conducted to evaluate asthma and allergic rhinitis presence among those with pediatric atopic dermatitis. These patients would initiate dupilumab treatment, with the investigators assessing dupilumab’s impact on these conditions.

This new research was led by Lisa P. van der Rijst, from the department of dermatology and allergology at the University Medical Center Utrecht in The Netherlands. The investigators noted that previous studies, though limited, had shown dupilumab had helped to diminish aeroallergen-specific IgE levels during treatment.²

“...(This) multidisciplinary study aimed to investigate the prevalence of the physician-diagnosed comorbidities asthma and (allergic rhinitis) in pediatric (atopic dermatitis) patients starting dupilumab treatment and to evaluate the effect of dupilumab treatment on these atopic comorbidities,” van der Rijst and colleagues wrote.

Background and Design

The research team used a prospective observational cohort design for their research, involving pediatric patients under 18 years old that also had moderate to severe atopic dermatitis and were given dupilumab. Each and every subject had been featured in the Dutch BioDay registry, a large prospective study which enrolled individuals with moderate to severe disease.

The trial was undertaken from August 2019 - September 2023 at the departments of dermatology and pulmonology at the Wilhelmina Children's Hospital, University Medical Center Utrecht in the Netherlands. Dupilumab was provided for the subjects subcutaneously, with a dosing regimen of 200 or 300 mg at a rate of every 2 or 4 weeks.

This also included a first dose of 400 or 600 mg at the point of baseline or 200 or 300 mg on the 15-day mark, depending on the age and weight of participants. In the study’s observation period, bronchodilators, inhaled corticosteroids, leukotriene receptor antagonists, antihistamines, nasal corticosteroids, topical corticosteroids, calcineurin inhibitors, and systemic immunosuppressants, were permitted.

All patients were evaluated by a pediatric pulmonologist for asthma as well as allergic rhinitis at the initiation of dupilumab therapy, with the clinician utilizing assessments of spirometry (evaluating FEV1 and FVC, both pre- and post-bronchodilation), FeNO, patient medical history, symptoms, and laboratory tests. In the laboratory, they assessed eosinophil levels, total IgE, aeroallergen-specific IgE (for birch pollen, dust mite, mugwort, timothy grass pollen, dog, cat, and Aspergillus fumigatus), and thymus- and activation-regulated chemokine (TARC).

Among those individuals with asthma diagnoses, the investigators repeated assessments of spirometry (pre-bronchodilation), laboratory tests, FeNO levels, and the CACT/ACT tests at the 16 and 52-week mark. Among those with allergic rhinitis, the team repeated their laboratory tests at the 16 and 52-week marks.

The research team determined their main endpoints of the research to be the prevalence of clinician-diagnosed asthma and allergic rhinitis. Additionally, they evaluated the effect of dupilumab on subjects’ FEV1 z-scores, FeNO, and sIgE levels from the point of baseline to Weeks 16 and 52.

Findings

The investigators concluded their research having assessed 84 participants in total, noting that asthma had been diagnosed in 59.5% and allergic rhinitis in 85.7%. The team reported elevated baseline FeNO levels among those with diagnoses of asthma (29.0 ppb, 95% CI 22.0-54.0) as well as subjects without asthma (26.0 ppb, 95% CI 22.0-30.0).

The investigators noted that FeNO levels during participants’ treatments had substantially decreased during treatment (P < .001). They also reported that AFEV1 scores had significantly increased (P < .001) among those with asthma.

Those subjects with asthma and/or allergic rhinitis saw their aeroallergen-specific IgE levels lower by 61.3% to 89.1% following a course of 52 weeks of therapy.

“In conclusion, this real-world study demonstrates the positive effect of dupilumab on pulmonary outcomes in pediatric AD patients with comorbid asthma and shows the profound decrease in aeroallergen-specific IgE levels in patients with comorbid asthma and/or AR,” they wrote. “In addition, this study demonstrates the importance of proactive identification of the clinically relevant comorbidities asthma and AR.”

References

1. ^{Rijst LPvd, Groot K-d, Zuithoff NPA, de Bruin-Weller MS, de Graaf M. Effect of dupilumab on asthma and aeroallergen sensitization in pediatric atopic dermatitis patients: Results of the BioDay registry. Pediatr Allergy Immunol. 2024; 35:e14178. doi:10.1111/pai.14178.}
2. ^{Geba GP, Li D, Xu M, et al. Attenuating the atopic march: meta-analysis of the dupilumab atopic dermatitis database for incident allergic events. J Allergy Clin Immunol. 2023; 151(3): 756-766.}