Monoclonal Antibody Improves Disease Control in Patients With Severe Asthma and CRSwNP

Treatment with dupilumab improved disease control and reduced exacerbations in patients with severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), according to findings published in Frontiers in Immunology. 

Dupilumab’s effectiveness lies in its ability to inhibit the underlying mechanisms responsible for type 2 inflammation, which is implicated in the pathophysiology of these conditions, researchers said.

The investigators sought to evaluate the real-life therapeutic impact of dupilumab in a large sample of people with severe asthma, taking into consideration their skin prick test (SPT) results and the presence or absence of CRSwNP. The study included 127 patients with severe asthma, of which 90 had a positive SPT, indicating an allergic component to their condition, and 78 reported the presence of CRSwNP. 

The patients were assessed at baseline and 24 weeks after the first administration of dupilumab. Various clinical, functional, and laboratory parameters were measured during these time points. Furthermore, a comparative analysis was conducted based on SPT positivity and the presence of CRSwNP.

The results demonstrated significant improvements in several key parameters following treatment with dupilumab. Asthma exacerbations decreased from an average of 4.0 in the six months preceding the treatment to 0.0 during the study period. Similarly, the daily intake of prednisone, a commonly used medication for asthma management, decreased from an average of 12.50 mg to 0.00 mg. These reductions were statistically significant. 

Moreover, asthma control, as measured by the asthma control test (ACT) score, showed a substantial increase from an average of 14 to 22. Additionally, the sinonasal outcome test (SNOT-22) score, which assesses the impact of nasal symptoms on patients' quality of life, significantly decreased from 55.84 ± 20.32 to 19.76 ± 12.76.

Pulmonary function tests revealed noteworthy improvements in forced expiratory volume in one second (FEV1), indicating enhanced lung function. The baseline FEV1 value increased from 2.13 L to 2.39 L after treatment with dupilumab. Furthermore, fractional exhaled nitric oxide (FeNO) levels, which are associated with airway inflammation, decreased from 27.0 ppb to 13.0 ppb.

These positive outcomes were observed irrespective of SPT results or the presence of CRSwNP. Whether patients had a positive or negative SPT or CRSwNP had no significant influence on the therapeutic response to dupilumab.

The study did not show any significant correlations between serum IgE levels, baseline blood eosinophils, or FeNO levels and the changes induced by dupilumab, except for a positive correlation between FEV1 increase and FeNO values.

“Our results consolidate the strategic position of dupilumab in its role as an excellent therapeutic option currently available within the context of modern biological treatments of severe asthma and CRSwNP, frequently driven by type 2 airway inflammation,” explained study authors.

Reference:
Pelaia C, Benfante A, Busceti MT, et al. Real-life effects of dupilumab in patients with severe type 2 asthma, according to atopic trait and presence of chronic rhinosinusitis with nasal polyps. Front Immunol. 2023;14:1121237. doi:10.3389/fimmu.2023.1121237