Dupilumab Effective in Treating Severe Asthma with Small Airway Dysfunction

A real-life study uncovered the positive effects of the drug Dupilumab on severe asthma patients, marking a significant advancement in asthma treatment. Dupilumab, a humanized immunoglobulin G (IgG)–4 monoclonal antibody, has demonstrated remarkable potential in improving asthma-related health parameters.

This innovative research delved into the impact of Dupilumab therapy on patients with uncontrolled severe asthma, specifically selected based on oscillometry-defined Small Airway Dysfunction (SAD). SAD, closely associated with type 2 inflammation and asthma control, was diagnosed when patients exhibited values of R5-R20 greater than or equal to 0.10 kPa/L/s and AX greater than or equal to 1.0 kPa/L at baseline.

The results of the study were astonishing. After only 4.5 months of Dupilumab therapy, significant improvements were observed in oscillometry outcomes. Median improvements in R5-R20 and AX exceeded previously established biologic variability values, indicating a clinically relevant treatment effect. Furthermore, the mean improvements in lung function (FEV1, FEF25-75, and FVC) were substantial, surpassing established biologic variability values for clinical relevance. These improvements were accompanied by significant enhancements in asthma control scores, more than threefold beyond the traditionally accepted minimal clinically important difference.

Out of the 16 patients involved in the study, 12 experienced improvements in oscillometry values exceeding biologic variability values. Notably, 13 patients exhibited enhancements in lung function metrics, and 12 experienced an improvement in asthma control scores greater than the minimal clinically important difference.

This study is the first of its kind to investigate the effects of Dupilumab therapy in patients with oscillometry-defined SAD. While the study acknowledges potential limitations, including its retrospective nature and a relatively small sample size from a single UK specialist center, the findings are undeniably promising.

Dupilumab's success in improving SAD outcomes, spirometry, fractional exhaled nitric oxide (FeNO) levels, and overall asthma control offers a ray of hope for those living with severe asthma. The results open the door to future research endeavors, including the ongoing VESTIGE trial (NCT04400318), which will explore the effect of Dupilumab on functional respiratory imaging as a primary outcome. These findings signify a significant leap forward in the treatment of severe asthma and could pave the way for tailored therapies in the future.

Source:

Chan, R., & Lipworth, B. (2023). Real-life effects of dupilumab on airway oscillometry in severe uncontrolled asthma. In Annals of Allergy, Asthma & Immunology. Elsevier BV. https://doi.org/10.1016/j.anai.2023.07.021