Dupilumab Reduces Exacerbation in Children With and Without Allergic Asthma

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According to a recent investigation, dupilumab significantly reduced the rate of severe exacerbations and improved lung function and asthma control in patients with type 2 asthma and evidence of allergic asthma, with similar trends observed in patients without evidence of allergic asthma.¹

The post hoc analysis of the Liberty Asthma VOYAGE trial was conducted in children aged 6-11 years with moderate-to-severe asthma. Investigators reported improvements in lung function and asthma control in the subgroup with evidence of allergic asthma were rapid, observed by week 2, and were sustained throughout the treatment period.

When compared with placebo, dupilumab also improved lung function in patients with type 2 without evidence of allergic asthma, although these differences were not significant at most time points.

Assessing Dupilumab for Type 2 Asthma

Type 2 inflammation is a key driver of asthma and is characterized by the activation of type 2 helper T cells and the production of cytokines such as interleukin (IL)-4, IL-5, and IL-13. Dupilumab is a human monoclonal antibody that inhibits the signaling of both IL-4 and IL-13 by blocking the shared receptor component.

Nikolaos G Papadopoulos, from the 2nd Pediatric Clinic, University of Athens, and a team of investigators evaluated the efficacy of dupilumab in a pediatric population of patients with a baseline serum total IgE ≥30IU/mL and ≥1 perennial aeroallergen-specific IgE ≥0.35kU/L.

The cases of 350 children were analyzed, with 261 having evidence of allergic asthma and 89 without.

The assessment included the annualized rate of severe exacerbations (AER) and changes in pre-bronchodilator (Pre-BD) forced expiratory volume in one second (FEV1), percent-predicted pre-BD FEV1 (ppFEV1), and Asthma Control Score (ACQ)-7 during the treatment period.

Dupilumab Reduces Asthma Exacerbations

The data suggested dupilumab has been shown to reduce the annualized asthma exacerbation rate (AER) in patients with and without evidence of allergic asthma when compared with placebo.

Specifically, the AER was significantly lower in patients with evidence of allergic asthma who received Dupilumab (0.24) compared with those who received placebo (0.62).

The relative risk reduction (RRR) was 62% with a 95% confidence interval (CI) of 39-76, P < .0001, indicating statistical significance.

Investigators observed the AER was also significantly lower in patients without evidence of allergic asthma who received dupilumab compared with those who received placebo (0.39 vs 0.80, RRR: 51% [95% CI, 0-76], P <.05) which suggested this result is also statistically significant.

Additionally, significant improvements were observed in ppFEV1, pre-bronchodilator FEV1, and ACQ-7 scores in those treated with dupilumab, with evidence of allergic asthma throughout the treatment period.

In patients without evidence of allergic asthma, numerical improvements in pre-bronchodilator FEV1 and asthma control were observed by week 52, but they were not statistically significant.

The post hoc analysis design could have limited the strength of the findings, the study noted. Despite this, investigators stated the results support the potential of dupilumab as a promising treatment option for children with type 2 asthma, especially those with evidence of allergic asthma.

References:

1. Papadopoulos NG, Szefler SJ, Bacharier LB, et al. Assessment of dupilumab in children with moderate-to-severe type 2 asthma with or without evidence of allergic asthma [published online ahead of print, 2023 Apr 14]. Allergy. 2023;10.1111/all.15743. doi:10.1111/all.15743