Add-On Drug Improves Asthma Control, Quality of Life

Adding twice-weekly 200 mg or 300 mg dupilumab (DPL) to inhaled corticosteroids plus a long-acting β2-agonist (ICS+LABA) therapy is associated with improved asthma control and quality of life in adults with uncontrolled, persistent asthma, according to a recent study.

Findings were presented at the CHEST Annual Meeting 2017, which is taking place from October 28 to November 1, 2017, in Toronto, Canada.
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Patients with uncontrolled, persistent asthma often have poor quality of life and a substantial disease burden. DPL is known to inhibit the signaling of interleukin-4 (IL-4) and IL-13, which play crucial roles in type 2 immune diseases, including atopic and allergic diseases.

For their study, the researchers assessed patients with 1 or more yearly exacerbations (n = 465), 2 or more (n = 227), 3 or more (n = 122), or 4 or more (n = 62). Patients were randomly assigned to receive either 200 mg or 300 mg DPL twice weekly or every 4 weeks, or placebo for 24 weeks. All patients in the study had already been receiving ICS+LABA therapy and had at least 1 exacerbation within 1 year before the study.

The 5-item Asthma Control Questionnaire (ACQ-5) and the Asthma Quality of Life Questionnaire (AQLQ) were used to determine the least squares (LS) mean changes from baseline at week 24 across all subgroups of exacerbation rates. Higher ACQ-5 scores indicated greater impairment, while higher AQLQ scores indicated lesser impairment. Adverse event reports and lab assessments were performed to assess safety.

Results indicated that, with twice-weekly 200 mg DPB, LS mean differences in ACQ-5/AQLQ scores at week 24 were -0.35/0.31 for 1 or more exacerbations, -0.68/0.64 for 2 or more exacerbations, -0.56/0.53 for 3 or more exacerbations, and -0.70/0.34 for 4 or more exacerbations, compared with placebo.

With twice-weekly 300 mg DPB, LS mean differences at week 24 were -0.31/0.36 for 1 or more exacerbations, -0.64/0.73 for 2 or more exacerbations, -0.86/1.03 for 3 or more exacerbations, and -0.92/1.11 for 4 or more exacerbations, vs placebo.

The researchers noted that the overall incidence of adverse events had been similar in patients on DPL (78%-80%) and placebo (75%).

“In this post hoc analysis, DPL 200 and 300 mg [every 2 weeks] dose regimens as add-on to ICS+LABA therapy in adults with uncontrolled persistent asthma showed improvement in asthma control and [quality of life] vs [placebo] in all subgroups,” the researchers concluded. “Greater improvement was observed as the number of exacerbations in the year prior to the study increased from [1 or more] to [4 or more], particularly in the 300 mg [every 2 weeks] dose regimen.”

—Christina Vogt

Reference:

Corren J, Castro M, Jayawardena S, et al. Dupilumab improves asthma control and asthma-related quality of life in uncontrolled persistent asthma patients across all baseline exacerbation rates. CHEST J. 2017;152(4):A26.  http://dx.doi.org/10.1016/j.chest.2017.08.056.