Dupilumab reduces OCS dose, improves lung function for asthma, CRSwNP

Dupilumab has been associated with reductions in exacerbations and oral corticosteroid (OCS) dosage, as well as improved lung function, in patients with OCS-dependent asthma with and without comorbid chronic rhinosinusitis with polyps nasal.

Dupilumab has been associated with reductions in exacerbations and oral corticosteroid (OCS) dosage, as well as improved lung function, in patients with OCS-dependent asthma with and without comorbid chronic rhinosinusitis with nasal polyps (CRSwNP). The findings were reported recently at the 2022 American Thoracic Society (ATS) International Conference.

More frequent exacerbations and airway obstructions have been observed in patients with severe asthma who do not respond to standard treatments, and these populations account for the majority of health care resource utilization and significantly high costs. .

Although long-term use of OCS is common in patients with severe asthma, researchers note that such use is associated with negative side effects, such as infections, bone and muscle disease, atrial fibrillation and hypertension.

“Comorbid severe CRSwNP increases disease burden and may pose additional treatment challenges,” they added.

The use of biologic therapies in patients with OCS-dependent asthma has shown promise in reducing OCS dosage, pharmacy claims for OCS, and asthma exacerbations leading to hospitalization. .

Additional efficacy has been demonstrated with the use of dupilumab, a fully human monoclonal antibody that blocks 2 key and central factors of type 2 inflammation (interleukin [IL]-4 and IL-13), in patients with OCS-dependent asthma in the VENTURE study (NCT02528214). The results were then maintained in this population in the open-label TRAVERSE study (NCT02134028).

The researchers conducted a post hoc analysis to further investigate the long-term efficacy of dupilumab in patients with OCS-dependent asthma with and without CRSwNP.

“Patients with OCS-dependent asthma received supplemental dupilumab 300 mg every 2 weeks (every 2 weeks) or placebo for 24 weeks in the VENTURE study (parent study), then dupilumab as an add-on 300 mg every 2 weeks for up to 96 weeks in the TRAVERSE study (dupilumab/dupilumab and placebo/dupilumab, respectively),” the researchers explained.

Patients with comorbid (n=61) and without (n=126) CRSwNP who participated in VENTURE and TRAVERSE were assessed on their unadjusted annualized rate of severe asthma exacerbation (AER) during the 96-week treatment period, mean change from parent study baseline (PSBL) in pre-bronchodilator forced expiratory volume in 1 second (FEV1), and mean OCS dose at weeks 0, 48, and 96.

Sustained improvement in clinical parameters over the period assessed in TRAVERSE was demonstrated in patients with and without CRSwNP, with those initially placed on placebo demonstrating rapid improvement in lung function upon initiation of dupilumab:

  • AERs were comparable between dupilumab/dupilumab-treated patients with and without CRS/PN comorbidity (0.353 vs 0.407)
  • AERs were low in placebo/dupilumab-treated patients with and without CRSwNP, but further decreased in the nonCRSwNP cohort (0.449 vs 0.211)
  • Patients treated with dupilumab/dupilumab with and without CRSwNP demonstrated PSBL improvements in pre-bronchodilator FEV11 during VENTURE, and these were maintained through week 96 in TRAVERSE
  • Patients treated with placebo/dupilumab also showed rapid PSBL improvements in pre-bronchodilator FEV11 from week 2 in TRAVERSE, and these were maintained through week 96
  • mean OCS doses were stable or decreased during TRAVERSE in patients with and without CRSwNP in the placebo/dupilumab and dupilumab/dupilumab groups

“In OCS-dependent asthmatic patients who participated in VENTURE and TRAVERSE, dupilumab produced durable reductions in exacerbations, improvements in lung function, and reductions in OCS dose,” the authors concluded. the study. “These clinical effects were seen in both patients with and without CRSwNP.”

Reference

Berger P, Menzies-Gow A, Peters AT, et al. Long-term efficacy of dupilumab in patients with oral corticosteroid-dependent asthma with and without chronic rhinosinusitis and/or comorbid nasal polyps. Presented at ATS 2022 International Conference. Abstract: C101.

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