Dupilumab treatment is safe and effective in children with asthma and high blood eosinophils
Published online November 26, 2024
Eosinophils play a key role in inflammation and asthma. In children with asthma, elevated blood eosinophil counts indicate a type 2 inflammatory response, which is associated with an increased risk of asthma exacerbations and more asthma symptoms. Dupilumab is a human monoclonal antibody that blocks important factors that drive type 2 inflammation. It has been shown to be a safe and beneficial treatment in children with uncontrolled moderate-to-severe type 2 asthma, including in those with blood eosinophil counts of ≥300 cells/µL at baseline. After starting dupilumab, a temporary increase in blood eosinophil counts can occur, but it rarely causes clinical symptoms or other side effects.
In this study, published in The Journal of Allergy and Clinical Immunology: In Practice, Jackson et al. assessed the safety and efficacy of dupilumab treatment in children with moderate-to-severe asthma who enrolled in the VOYAGE study, with a focus on children who had baseline blood eosinophil counts between 500 and 1500 cells/µL.
The investigators found that, of the 174 children included in the analysis, the safety and efficacy of dupilumab was consistent with the overall population that enrolled in the VOYAGE study (408 children total). Treatment with dupilumab reduced severe asthma exacerbation rates by 67% and improved lung function (increasing the amount of air a patient is expected to be able to blow out in 1 second) compared with placebo.
As anticipated, transient increases in eosinophils were seen with the initiation of dupilumab. These reduced by week 24 and fell below baseline levels by study end (week 52). Assessment of both general and eosinophil-related safety in this population demonstrated a similar rate of adverse events between the children treated with dupilumab versus placebo.
These results suggest that children with elevated blood eosinophil counts (≥500 cells/µL) are not at increased risk for significant on-treatment eosinophilia (high levels of eosinophils in the blood, defined as >3000 cells/µL) with dupilumab, thus suggesting that clinicians do not need to assess eosinophil counts after initiating dupilumab, unless there is concern for symptomatic eosinophilia. Dupilumab also demonstrated significant benefits in both exacerbation risk and lung function improvement, suggesting it is a safe and beneficial treatment option for these children.
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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