Short-Term Evaluation of Dupilumab Effects in Patients with Severe Asthma and Nasal Polyposis

Abstract

Background: Having been approved for biological treatment of atopic dermatitis, dupilumab has also been recently licensed as add-on therapy for severe asthma and nasal polyposis. With regard to the latter diseases, few real-life clinical investigations have been carried out to date.

Objective: The primary end point of this single-center observational study was to evaluate in a real-life setting the short-term therapeutic effects of dupilumab in patients with severe asthma and nasal polyposis.

Methods: At baseline and after 4 weeks of add-on therapy with dupilumab, several clinical and functional parameters were assessed in 20 patients with severe asthma and nasal polyposis, including both allergic and nonallergic subjects.

Results: After 4 weeks of treatment with dupilumab, all patients experienced remarkable improvement in both severe asthma and nasal polyposis. In particular, asthma-control test and sinonasal outcome test 22 scores had significantly increased (p<0.0001) and decreased (p<0.0001), respectively. Oral corticosteroid intake got to zero within 4 weeks (p<0.0001). Moreover, in week 4, significant increases were detected with regard to both prebronchodilator forced expiratory volume in the first second (p<0.01) and forced vital capacity (FVC; p<0.05). At the same time point, dupilumab had significantly reduced residual volume (p<0.0001) and total lung capacity (p<0.001), whereas it had enhanced forced midexpiratory flow of 25%-75% FVC (p<0.01) and peak expiratory flow (p<0.01). After 4 weeks of treatment, dupilumab had also lowered levels of fractional exhaled nitric oxide (p<0.0001).

Conclusion: The results of this real-life study suggest that dupilumab can be utilized in both allergic and nonallergic patients with severe asthma and nasal polyposis as a valuable add-on biological therapy with rapid onset of action.

Keywords: dupilumab; interleukin 4 receptor; nasal polyposis; severe asthma.

Figure 1

Clinical effects of dupilumab, with regard to ACT score (A), SNOT-22 score (B), and prednisone intake (C). ACT and SNOT-22 values expressed as means ± SD; prednisone intake expressed as medians (IQR). ****p<0.0001.

Figure 2

Functional effects of dupilumab with regard to FEV₁ (A), FVC (B), RV (C), TLC (D), FEF_25–75 (E), and PEF (F). All parameters expressed as means ± SD. *p<0.05; **p<0.01; ***p<0.001; ****p<0.0001.

Figure 3

Effects of dupilumab on biomarkers with regard to FeNO (A), blood eosinophils (B), and blood basophils (C). All parameters expressed as medians (IQR). ****p<0.0001.