The following is the summary of “Dupilumab Is Effective in Patients With Moderate-to-Severe Uncontrolled GINA-Defined Type 2 Asthma Irrespective of an Allergic Asthma Phenotype” published in the November 2022 issue of Allergy and Clinical Immunology: In Practice by Rabe, et al.
Patients with type 2 inflammation (blood eosinophils ≥150 cells/μL, fractional exhaled nitric oxide [FENO] ≥20 parts per billion, or allergic asthma) whose asthma is not controlled by high-dose inhaled corticosteroids should be evaluated for add-on biologics, according to the Global Initiative for Asthma report. Patients with uncontrolled moderate to severe asthma, defined as eosinophils more than or equal to 150 cells/μL and/or Feno greater than or equal to 25 parts per billion, responded well to add-on dupilumab versus placebo in the QUEST (NCT02414854) trial. Evaluate the efficacy of dupilumab in individuals with a type 2 phenotype, either with or without an allergic asthma phenotype.
Dupilumab 200/300 mg was added to matched placebo every 2 weeks for 52 weeks for patients aged 12 and up. Baseline serum total IgE greater than or equal to 30 IU/mL and 1 or more perennial aeroallergen-specific IgE levels greater than or equal to 0.35 kU/L were used to define the allergic asthma phenotype. Patients with an allergic phenotype and a baseline blood eosinophil count greater than or equal to 150 cells/μL and/or Feno greater than or equal to 20 ppb were compared to patients with a nonallergic phenotype in terms of the annualized rate of severe asthma exacerbations and changes in pre- and post-bronchodilator FEV1. Among the QUEST cohort of 1,902 patients, 83.3% had eosinophils and/or Feno levels above Global Initiative for Asthma standards, and 56.9% showed evidence of allergic asthma.
Significant improvements in pre- and post-bronchodilator forced expiratory volume in 1 (FEV1) were seen in individuals with increased type 2 biomarkers, regardless of whether or not they showed indications of an allergic asthma phenotype, after treatment with dupilumab (48.8% reduction, 64.0% reduction). Dupilumab was shown to dramatically reduce exacerbations and improve lung function in people with type 2 biomarkers above Global Initiative for Asthma standards. The presence of allergies has no bearing on how effective the treatment was.