Dupilumab in the Treatment of Severe Asthma in Real-World Practice
A freshly published French study is the first to confirm the results of clinical trials with dupilumab in patients with severe asthma in real-world practice.
Early Access Program
Dupilumab is a monoclonal antibody against interleukin IL-4Rα developed for the treatment of severe asthma bronchiale. In France, an early access program to this drug was opened for patients with severe asthma and unacceptable side effects of corticosteroids or life-threatening exacerbations.
Retrospective Study
A multicentric retrospective study evaluated changes in asthma control in these patients after 12 months of treatment with dupilumab in real-world practice conditions. A total of 64 patients were included (median age 51 years, 53% women), who were added dupilumab to their maximum standard care.
Results
After 12 months, the median asthma control test score improved from 14 to 22 (p < 0.001), the median one-second vital capacity (FEV1) increased from 58 to 68% (p = 0.001), and the median daily dose of oral prednisone decreased from 20 to 5 mg (p < 0.001). The median number of exacerbations dropped from 4 to 1 per year (p < 0.001).
In 25% of patients, an increased number of eosinophils (≥ 1500/mm3) was recorded at least once during follow-up, and in 14%, it persisted even after 6 months. However, it did not affect the response to treatment.
The most commonly reported adverse event was injection site reaction (in 14% of patients).
Conclusion
In the observed population of patients with severe asthma, mainly treated with oral corticosteroids, dupilumab significantly improved asthma control and lung function, and reduced the use of oral steroids and the frequency of exacerbations.
Where to Refer Patients with Severe Asthma and/or Severe Atopic Dermatitis?
Patients with severe asthma should be referred to one of the 13 centers operating at regional and faculty hospitals. A complete list can be found at the following link: www.tezke-astma.cz/index.php?pg=narodni-centrum-pro-tezke-astma. Specialists in the diagnosis and treatment of patients with severe asthma will examine complicating factors and comorbidities, confirm the diagnosis, and propose the most appropriate treatment. This may include biological treatments that patients may not have access to with their treating physician. Similarly, patients with severe atopic dermatitis should be referred to one of the 18 centers for biological treatment. A complete list, including contacts to these centers, is available here: www.dermanet.cz/cs/kozni-ordinace/centra-biologicke-lecby.
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Sources:
- Dupi C., Belhadi D., Guilleminault L. et al. Effectiveness and safety of dupilumab for the treatment of severe asthma in a real-life French multi-centre adult cohort. Clin Exp Allergy 2020 Jul; 50 (7): 789–798, doi: 10.1111/cea.13614.
- Sedlák V. Obtížně léčitelné astma. Česká iniciativa pro astma, 2019. Available at: www.cipa.cz/tezke-a-obtizne-lecitelne-astma-bronchiale
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