Can Young Adults with Uncontrolled Asthma Switch from Omalizumab to Dupilumab?

Portrait of a two years old boy coughing from the allergy.

At the time of the study’s analysis, Omalizumab was the only biologic option approved by the U.S. Food and Drug Administration to treat severe asthma in children aged younger than 12 years. At this time, it is no longer the only approved biologic. There is limited guidance, though, on treating severe asthma in adolescent patients. A study that was published as part of the AAAAI Annual Meeting assessed outcomes in adolescent/young adults with severe persistent atopic asthma whose disease was uncontrolled on omalizumab and who switched to dupilumab.

The case series included six patients who were taking omalizumab from seven months to six years without adequate disease control. After the switch, all patients presented improvements in forced expiratory volume in one second (FEV1); the mean improvement in FEV1 percent predicted was 38%. One patient had three asthma-related hospitalizations during the year before dupilumab initiation and had none in the first seven months after switching to dupilumab. Four patients had at least one steroid burst during the three months leading up to dupilumab initiation followed by no steroid bursts during the first three months of dupilumab treatment. One patient terminated chronic oral steroid use after switching to dupilumab. Another patient had previously failed mepolizumab and omalizumab and achieved disease control with dupilumab.

“Pediatric and adolescent [patients with asthma] typically have atopic phenotype, the authors summarized. “While omalizumab is the only biologic specifically indicated for atopic asthma, dupilumab, an anti-IL4R antagonist, also impacts atopic diseases. Dupilumab may offer control for atopic adolescent [patients with asthma] with uncontrolled disease on omalizumab. This case series exhibits [a] need for better understanding of biologic treatment options for each asthma phenotype and endotype to avoid preventable morbidity.”

https://www.jacionline.org/article/S0091-6749(19)32489-3/fulltext