Dupilumab for Moderate to Severe Asthma

Transcript:Thomas Casale, MD: Geoff, what do you think about comorbid diseases when you’re picking a biologic and specifically, when would you pull the trigger on saying this patient’s a good candidate for dupilumab?

Geoffrey L. Chupp, MD: I think that dupilumab really has that feature where it has multiple indications right now for diseases that do track with asthma severity, nasal polyposis and atopic dermatitis. In the pulmonary practice, I don’t think we see a lot of severe atopic dermatitis. That probably occurs a lot more in allergy practices. Usually it’s very easy to pull the trigger on moving to dupilumab in a patient who has a chronic sinusitis with nasal polyposis, has had multiple surgeries and has severe, uncontrolled asthma. The minute you mention to a patient that we may have an opportunity to control both...sinus disease and asthma with 1 drug, they get very excited, so it’s not really a very difficult discussion to have. That’s usually the easiest to consider.

I think with some of the other drugs, we’re hoping to have clinical trial data for all these agents that will be helpful in this kind of regard any kind of comorbidity I think really makes it a lot easier to move to a biologic because the T2 [type 2] inflammatory diseases occurring at different locations really all overlap. For example, with mepolizumab, they have an indication for Churg-Strauss syndrome. When you see these patients who, as Michael knows as our author of the study in the New England Journal of Medicine, a lot of them don’t have classic biomarker evidence of autoimmune disease. But they can overlap.

The other [situation] where we consider moving to a different biologic for other indications is with the mepolizumab and Churg-Strauss syndrome there are patients who have Churg-Strauss without a lot of biomarker evidence of autoimmune disease but have either some patchy infiltrates in their lungs or a little bronchiectasis where there may not be classic asthma abnormalities, and we will increase their mepolizumab dose or use the 300-mg-a-month dose and achieve control of all their symptomatology.

The other place, of course, as you mentioned, is with CIU [chronic idiopathic urticaria] and allergic asthma. There are patients whose comorbidities benefit from omalizumab for more than 1 reason.

Transcript Edited for Clarity