Dupilumab Reduces Severe Exacerbations in Patients with Type 2 Asthma

Eric D. Batemen, MD

Recent data showed that the oral biologic dupilumab (Dupixent) reduced severe exacerbations such as asthma attacks and improved long-term lung function for up to 96 weeks in adults and adolescents with evidence of type 2 inflammation irrespective of allergic phenotype.

The findings were presented at the European Respiratory Society (ERS) 2021 International Congress.

Dupilumab is a fully human monoclonal antibody with the capabilities of blocking the shared receptor component for interleukin-4 and IL-13, the key drivers of type 2 inflammation in various diseases.

Investigators led by Eric D. Batemen, MD, University of Cape Town Lung Institute, South Africa, noted that dupilumab significantly reduced severe asthma exacerbations and improved pre-bronchodilator FEV1 compared to placebo, which was recorded in the LIBERTY ASTHMA QUEST data.

In that study, investigators also found that 29.6% (n = 103) of dupilumab-treated patients were exacerbation free at week 24 compared to 7.7% (n = 15) of the placebo group, with an ACQ-5 score of less than 1.5 and post-bronchodilator FEV1 of at least 80%, which was classified as clinical remission.

In the recent study, Batemen and colleagues analyzed the QUEST/TRAVERSE study population with and without evidence of an allergic asthma phenotype at baselineand with characteristics of a type 2 inflammatory phenotype per GINA criteria.

The Study

Batemen and investigators recruited participants from the LIBERTY ASTHMA QUEST trial, all of whom were ages 12 and older.

Patients from the LIBERTY ASTHMA QUEST trial who enrolled in the OLE LIBERTY TRAVERSE study included those with or without evidence of an allergic asthma phenotype, as well as blood eosinophils ≥ 150 cells/µL at baseline, and FeNO ≥ 20 ppb at baseline.

The investigators established a dupilumab group and a placebo group. Participants in the dupilumab received 200 to 300 mg of the biologic every 2 weeks.

Annualized exacerbation rates in patients with type 2 asthma with and without evidence of allergic phenotypes were recorded, as well as changes in pre-bronchodilator FEV1 in those same groups.

Overall outcomes were recorded at 96 weeks.

The Findings

The results of the TRAVERSE study mirrored those recorded in the QUEST study.

Annualized asthma attack rates in people with ≥150 blood eosinophils/µL were 0.32 vs 0.37 in allergic and 0.27 vs. 0.30 in non-allergic people.

Additionally, LS mean improvement in FEV1 from QUEST baseline in people with ≥150 blood eosinophils/µL was 0.35L vs. 0.39L in allergic and 0.36L vs. 0.37L in non-allergic people.

Batemen and colleagues recorded that dupilumab reduced the exacerbation rate in patients with type 2 inflammatory asthma. Improved pre-bronchodilator FEV1 was also recorded, which was sustained for the 96 weeks of the study.

As referenced earlier, allergic phenotypes did not influence the results of the study.