Dupilumab: an effective oral-corticosteroid-sparing treatment for severe asthma
Published: April 7, 2022
For patients whose asthma is inadequately controlled by inhaled therapy, long-term use of oral corticosteroids (OCS) has been the norm until the advent of biologic therapies that target the type 2 inflammation underlying the disease. Although several biologics that inhibit type 2 inflammatory pathways have been approved to treat severe asthma, between one third and one half of patients with severe asthma continue to receive treatment with OCS on an ongoing, long-term basis. The problem with this approach is that OCS can have multiple unwanted side effects and they are also associated with greater healthcare costs and resource utilization. Use of OCS can be reduced or avoided by treatment with biologics that inhibit type 2 inflammation, such as dupilumab, but whether OCS use can be spared by treatment with dupilumab in patients with varying baseline OCS doses was unknown.
To address this question Domingo et al. analyzed data from the phase 3 VENTURE study in which addition of dupilumab to OCS was shown to enable patients to significantly reduce the dose of OCS needed to maintain control of asthma symptoms. Safety findings were consistent with the known dupilumab safety profile. In that study, patients had been taking OCS at doses between 5 mg and 35 mg per day before they received dupilumab. In the analysis now reported here in The Journal of Allergy and Clinical Immunology: In Practice, outcomes were compared in patients taking OCS at doses less than 10 mg per day and in those taking 10 mg or more per day at the beginning of VENTURE. The main outcome analyzed was the amount by which the OCS dose was reduced from baseline 24 weeks after starting dupilumab. Also evaluated during the 24 weeks of treatment were severe asthma exacerbation rates and change in lung function.
Domingo et al. found that use of dupilumab allowed patients taking less than 10 mg of OCS per day to reduce their daily OCS dose on average from 6.1 mg to 1.2 mg at week 24, one fifth of their original dose; patients taking 10 mg or more of OCS were able to reduce their daily OCS dose on average from 14.5 mg to 4.7 mg at week 24, or one third of their original dose. Dupilumab also allowed large numbers of patients to stop taking OCS entirely (more than 70% of those originally on the low dose of OCS and almost 40% of those on the high dose). In both baseline OCS dose groups, severe asthma exacerbation rates were reduced in patients treated with dupilumab compared to placebo during the 24-week treatment period, and lung function was preserved or improved despite the reduction of OCS dose. Overall, dupilumab not only permitted significant OCS dose reduction and increased the likelihood of no longer needing OCS, but it also improved clinical outcomes irrespective of the patients’ original OCS dose category.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.