Adults taking dupilumab for atopic dermatitis also see improvements in mild asthma
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Adults who were taking dupilumab for their atopic dermatitis also experienced significant improvements in their mild asthma, primarily in the first 16 weeks, according to a study published in Clinical and Translational Allergy.
Led by Lotte S. Spekhorst, MD, department of dermatology and allergology and National Expertise Center for Atopic Dermatitis at University Medical Center Utrecht, the Netherlands, the study involved 304 adults with mild asthma receiving dupilumab (Dupixent; Sanofi Genzyme, Regeneron) for AD.
Mean Asthma Control Questionnaire (ACQ)-5 scores significantly improved from 1.32 (95% CI, 1.2-1.45; n = 236) at baseline by –0.24 (95% CI, –0.38 to -0.1; n = 173) at week 16 and –0.26 (95% CI, –0.43 to –0.09; n = 110) at week 52.
Also, mean FEV1 significantly improved from 2.96 L (95% CI, 2.79-3.13; n = 104) at baseline by 0.1 L (95% CI, 0.03-0.16; n = 81) at week 16 and 0.12 L (95% CI, 0.05-0.19; n = 64) at week 52.
Median fractional exhaled nitric oxide significantly decreased from 22.43 ppb (95% CI, 16.37-33.53; n = 22) at baseline to 13.13 ppb (95% CI, 10.49-16.45; n = 17) at week 16, increasing to 15.24 ppb (95% CI, 12.38-18.76; n = 21) at week 52.
The proportion of patients with an ACQ-5 score of less than 0.5 increased from 20.8% at baseline to 28.2% at week 52. Similarly, the proportion of patients with an FEV1 percentage of 80% or higher increased from 58.7% to 68.8%.
However, the researchers did not find any profound effect of type 2 (T2)-indicator blood eosinophilia at the start of treatment with dupilumab indicating its effectiveness on FEV1, suggesting that the effect of dupilumab on patients with mild asthma may depend less on T2-indicator blood eosinophilia.
Considering these findings, the researchers wrote that patients who receive dupilumab for their AD experience additional benefits if they also have asthma.
Perspective
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This is not something new, as previous reports have showed similar effects. However, in the current study, the authors used objective measures such as FEV1 and FeNO to assess lung function in asthma. The results also coincide well with my clinical experience, as patients benefit for both diseases, which involve type 2 inflammation.
It would be of interest to see data on patients who have, in addition to AD and asthma, rhinosinusitis and/or eosinophilic esophagitis and/or chronic urticaria, as this drug works for all these indications. Further, it would be interesting to see whether there is any specific subset of those patients who are higher responders than others, if there are any who are nonresponders, and if there are any biomarker indicators.
Perspective
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Clifford Bassett, MD, FAAAAI, FACAAI
The authors reported a positive effect with the use of the biologic agent dupilumab on comorbid asthma among patients with AD. Further, they identified a significant number of patients who had relatively mild asthma.
Currently, dupilumab is approved by the FDA as an add-on maintenance treatment for adults and children aged 6 years and older with moderate to severe asthma characterized by an eosinophilic phenotype or with oral corticosteroid-dependent asthma.
Recently, it is important to note, that as per the 2022 Global Initiative for Asthma Report on Global Strategy for Asthma Management and Prevention, when it comes to classifying asthma severity, the term “mild” asthma should be curtailed, as its interpretation may vary by clinicians, and further discussion is needed with respect to the definition of mild asthma and control of patient symptoms.
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Spekhorst LS, et al. Clin Transl Allergy. 2023;doi:10.1002/clt2.12219.
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