Updated Evaluation of Dupilumab in the Treatment of Asthma: Patient Selection and Reported Outcomes

Abstract

Uncontrolled asthma continues to be a problem for many patients with moderate-to-severe allergic asthma. Dupilumab, which blocks the receptors for interleukin-4 and interleukin-13, has been effective in reducing asthma exacerbations, improving forced expiratory volume in one second (FEV₁), and reducing oral corticosteroid use. When selecting patients for dupilumab, it is important to consider entry criteria for the original studies, subgroups that have responded best, and the presence of comorbid diseases that may also respond to dupilumab. Factors that were considered when selecting patients likely to respond to dupilumab in asthma studies include: failure of moderate or high dose inhaled steroids in combination with an additional controller medication, baseline FEV₁ reversibility of 12% or greater, and Asthma Control Questionnaire > 1.5. The baseline characteristics that predicted a better response to dupilumab included blood eosinophils > 150 cells/mm³ and fractional exhaled nitric oxide > 25 parts per billion. Comorbidities that may also respond to treatment with dupilumab include atopic dermatitis, chronic rhinosinusitis, and allergic rhinitis. A combination of these factors should be considered when selecting the patients most likely to benefit from dupilumab.

Keywords: allergic asthma; comorbidity; dupilumab; eosinophils; nitric oxide.

Figure 1

Asthma related actions of interleukin-4 and interleukin-13. Abbreviations: IL-4, interleukin-4; IL-13, interleukin-13; IL-5, interleukin-5; IgE, immunoglobulin E; Th2, T helper 2.