Dupilumab in the treatment of asthma

Abstract

Dupilumab is a fully human monoclonal antibody against the interleukin (IL)-4 and IL-4/IL-13 receptor complexes. These are key cytokines in driving type 2 inflammation, a dominant and largely inflammatory pathway in asthma. Trials evaluating the efficacy of dupilumab in asthma include three pivotal, placebo-controlled, phase 2b or 3 trials of 24-52 weeks treatment duration in patients aged below 12 years with moderate-to severe asthma (inadequately controlled with medium-to-high dose inhaled corticosteroids) or severe asthma (dependent on oral corticosteroids for control). In these studies, adding subcutaneous dupilumab to background therapy was generally well tolerated and reduced the rate of severe asthma exacerbations, improved lung function, as well as asthma control and, health-related quality of life, and enabled oral corticosteroids maintenance doses to be reduced without impacting asthma control. Dupilumab displayed efficacy across various patient subgroups, although those with heightened type 2 immune activity, tended to have a more prominent treatment benefit. Dupilumab is consequently widely indicated (and a valuable treatment option) as an add-on therapy in patients aged below 12 years who have severe/moderate-to-severe asthma with a type 2 inflammation/eosinophilic phenotype despite conventional treatments or have oral corticosteroids-dependent asthma.