Dupilumab Effective Add-On Therapy in Aspirin-Exacerbated Respiratory Disease

Cropped shot of an attractive young businesswoman sitting alone in her office and coughing as she suffers from a cold

About 7% of patients with asthma suffer from aspirin-exacerbated respiratory disease (AERD). Usual asthma and/or nasal polyposis therapies are not significantly effective, leaving patients with decreased quality of life.

A study that was published as part of the AAAAI Annual Meeting evaluated the efficacy of dupilumab as an add-on therapy for AERD with uncontrolled chronic rhinosinusitis with nasal polyposis (CRSwNP). Patients were given placebo for four weeks, followed by dupilumab for 24 weeks. The main outcome measure was change in Sino-Nasal Outcome Test (SNOT-22); additional outcomes included changes in University of Pennsylvania Smell Identification Test (UPSIT), Asthma Control Test (ACT), Mini Asthma Quality of Life Questionnaire (AQLQ), Lund-MacKay score (LMK), spirometry, fractional excretion of nitric oxide (FeNO), urinary leukotriene E4 (LTE4), and serum immunoglobulin E (IgE).

At the time of the abstract’s publication, nine of 10 patients had completed the study. The median age was 48 years. Three patients underwent sinus surgeries, and three had courses of systematic steroids over the last year. SNOT-22 improved from 37 at baseline to 10 at six months (P=0.008). Improvements were also observed in secondary outcomes, including UPSIT (11 vs. 32; P=0.038), ACT (22 vs. 25; P=0.028), mini-AQLQ (98 vs. 102; P=0.028), LMK (21 vs. 3; P=0.008), FeNO (21 ppb vs. 8 ppb; P=0.008), urinary LTE4 (258 IU/mL vs. 100 IU/mL; P=0.021), and total serum IgE (65 IU/mL vs. 16 IU/mL; P=0.008).

The study authors summarized, “Dupilumab was highly effective as add-on therapy for CRSwNP in AERD, improving patient-reported outcomes, sinus imaging, and markers of T2 inflammation.”

https://www.jacionline.org/article/S0091-6749(19)32062-7/fulltext