Published online: July 24, 2019
Patients with asthma frequently have comorbid chronic rhinosinusitis (CRS). These patients are typically more difficult to treat, with few treatment options and poor quality of life. Type 2 cytokines, including IL-4 and IL-13, are known to play a role in both asthma and CRS, causing mucosal inflammation of the upper and lower airways respectively. Dupilumab is a fully human monoclonal antibody that blocks the shared receptor component of IL-4 and IL-13, thus inhibiting these key drivers of type 2 inflammation.
In the phase 3 LIBERTY ASTHMA QUEST study, dupilumab 200mg and 300mg every 2 weeks versus placebo reduced severe asthma exacerbations, and improved lung function and quality-of-life in patients with uncontrolled, moderate-to-severe asthma. In a recently published paper in The Journal of Allergy and Clinical Immunology: In Practice, Maspero and colleagues describe a post hoc analysis of this trial, in which the efficacy and safety of dupilumab was evaluated in uncontrolled, moderate-to-severe asthma patients with or without self-reported CRS.
In the study population at baseline, asthma patients with self-reported CRS had a significantly greater history of severe exacerbations, and significantly higher levels of the type 2 inflammatory biomarkers FeNO and blood eosinophils, than those without CRS. Dupilumab reduced asthma exacerbations, and improved lung function, asthma control, and quality of life in patients with and without CRS. Consistent with its mechanism of action, dupilumab reduced biomarkers of type 2 inflammation in both subgroups. Patients with CRS had equal or greater improvements in responses to dupilumab in comparison to those without CRS. Dupilumab also improved CRS specific measures and was generally well tolerated.
Dupilumab was effective in the treatment of patients with moderate-to-severe asthma and self-reported CRS. Patients with asthma and comorbid CRS may benefit from dupilumab treatment via reducing type 2 mediated inflammation in both the upper and lower airways.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.