Dupilumab treatment improves pediatric asthma outcomes in children receiving medium or high doses of inhaled corticosteroids
Published online August 27, 2024
Asthma is the most prevalent chronic disease among children, and its prevalence is increasing. Type 2 asthma is a form of severe asthma in which the immune system causes chronic inflammation in the airways. This type 2 inflammation is a common cause of severe asthma in children. While for most patients asthma can be managed with low or medium doses of inhaled corticosteroids (ICS) plus an inhaler (long-acting β2-agonist), more severe cases often remain uncontrolled with these treatments. Dupilumab is a human monoclonal antibody that blocks key pathways of type 2 inflammation. Previous studies have shown that add-on dupilumab is effective and safe for treating children with uncontrolled moderate-to-severe type 2 asthma.
In their study published in The Journal of Allergy and Clinical Immunology: In Practice, Dr. Maspero et al. assessed the effects of dupilumab treatment in children with uncontrolled, moderate-to-severe type 2 asthma, grouped according to their strength of ICS dose at the start of the study. Using data from the VOYAGE clinical study, they assessed rates of severe asthma exacerbations (or flare-ups), as well as changes in lung function and asthma control in children aged 6 to 11 years receiving dupilumab for 52 weeks, who were also receiving either medium- or high-dose of ICS.
Through this analysis, the investigators found that across both ICS-dose groups, dupilumab reduced severe exacerbation rates by 59–63% and significantly improved lung function and asthma control (measured using the Interviewer Administered 7-item Asthma Control Questionnaire) in this pediatric population.
These results have the potential to have an impact on current asthma management guidelines as they confirm that dupilumab combined with ICS is an important tool for clinicians treating children whose moderate-to-severe type 2 asthma remains uncontrolled despite receiving the highest tolerated ICS dose. Long-term treatment goals for these patients include minimizing the risks of asthma exacerbations, airflow limitation, and side effects, as well as good symptom control, plus minimizing overall dose of ICS and oral corticosteroids. Achieving these treatment goals is crucial for children with asthma, as early lung function decline and reduced lung growth in childhood can negatively affect lung function into adolescence and adulthood.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.
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