Alleviation of Asthma and Chronic Sinusitis Symptoms in Patients with Atopic Dermatitis Thanks to Dupilumab
An analysis of results in adult patients with moderate to severe atopic dermatitis, who also had asthma and/or chronic rhinosinusitis, investigated how clinically and statistically significant the benefit of dupilumab is for all these 3 conditions in comparison with a placebo.
Introduction
Atopic dermatitis is a chronic inflammatory skin disease often associated with type 2 inflammation, similar to asthma, allergic rhinitis, and chronic rhinosinusitis. These diseases often occur together, representing a significant burden for the patient and complicating treatment.
Dupilumab is a fully human monoclonal antibody that blocks the common receptor for interleukins 4 and 13 involved in type 2 inflammation. Dupilumab has demonstrated efficacy and safety in clinical studies with patients with moderate to severe atopic dermatitis, as well as other diseases associated with type 2 inflammation, such as asthma or chronic rhinosinusitis with nasal polyps. However, the efficacy of dupilumab on the concurrent presence of these diseases has not yet been evaluated.
Analyzed Data
A post-hoc analysis of 4 randomized placebo-controlled phase III studies (LIBERTY AD SOLO 1 and SOLO 2, CHRONOS, and CAFÉ) evaluated the effects of dupilumab at a dose of 300 mg every 2 weeks or 300 mg once weekly on the alleviation of asthma and chronic rhinosinusitis in adult patients with moderate to severe atopic dermatitis. Asthma alleviation was measured using the 5-item ACQ-5 (Asthma Control Questionnaire) and rhinosinusitis alleviation using the 22-item SNOT-22 (Sino-Nasal Outcome Test). The effect of dupilumab on the manifestations and symptoms of atopic dermatitis was also evaluated in all patients.
Results
Of the 2444 participants in the mentioned studies, 463 (19%) patients had asthma with an ACQ-5 score ≥ 0.5 at the study entry, 1171 (48%) had sinonasal disease, and 311 (13%) had both conditions concurrently.
After 16 weeks of treatment, the ACQ-5 score improved by 0.27 with placebo, by 0.59 with dupilumab administered every 2 weeks, and by 0.56 with weekly dupilumab. The SNOT-22 score improved by 5.1 in the placebo group compared to an improvement of 9.9 in the group with dupilumab administered every 2 weeks and 10.8 in the group with weekly dupilumab. For all comparisons of dupilumab with placebo, p < 0.01.
Improvement in ACQ-5 and SNOT-22 scores was also observed in patients with both asthma and chronic rhinosinusitis. In all subgroups, dupilumab also alleviated the symptoms of atopic dermatitis.
Conclusion
By inhibiting type 2 inflammation, dupilumab can improve the treatment of atopic dermatitis, asthma, and chronic rhinosinusitis even when these conditions occur together.
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Source:
Boguniewicz M., Beck L. A., Sher L. et al. Dupilumab improves asthma and sinonasal outcomes in adults with moderate to severe atopic dermatitis. J Allergy Clin Immunol Pract 2021 Mar; 9 (3): 1212-1223.e6, doi: 10.1016/j.jaip.2020.12.059.
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