Dupilumab Is an Effective Add-On Therapy for Aspirin-Exacerbated Respiratory Disease

After careful consideration, the American Academy of Allergy, Asthma & Immunology canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from March 13 to 16, because of concerns regarding the coronavirus disease 2019 (COVID-19) outbreak. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting.

Dupilumab is a highly effective add-on therapy for uncontrolled chronic rhinosinusitis with nasal polyposis (CRSwNP) in aspirin-exacerbated respiratory disease (AERD), improving sinus imaging, markers of T2 inflammation, and patient-reported outcomes, according to research intended to be presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting.

In this 6-month, single-blinded trial, researchers sought to evaluate the efficacy of dupilumab for uncontrolled CRSwNP in AERD.

Patients received 4 weeks of placebo, followed by 24 weeks of dupilumab. The primary study outcome was change in Sino-Nasal Outcome Test (SNOT-22). Secondary outcomes included change in Asthma Control Test, measurement of fractional nitric oxide in exhaled breath (FeNO), Lund-MacKay score, Mini Asthma Quality of Life Questionnaire (AQLQ), serum immunoglobulin E (IgE), spirometry, University of Pennsylvania Smell Identification Test (UPSIT), and urinary leukotriene E4 (LTE4). These changes were compared using the Wilcoxon-paired sign rank test.

Of the 10 participants, 9 completed the study, with a median age of 48 years, 3 sinus surgeries, and 3 courses of systemic steroids during the previous year. Significant improvements were seen in SNOT-22 from baseline (37; interquartile [IQ], 31-60) to 6 months (10 [IQ, 4-20]); P =.008]. Significant improvements were also seen in secondary outcomes, including ACT (22 [IQ, 21-25] to 25 [IQ, 23-25]; P =.028); FeNO (21 ppb [IQ, 13-36 ppb] to 8 ppb [IQ, 6-18 ppb]; P =.008); Lund-MacKay score  (21 [IQ, 17-23] to 3 [IQ, 2-6]; P =.008); mini-AQLQ (98 [IQ, 90-104] to 102 [IQ, 98-105]; P =.028), total serum IgE (65 IU/mL [IQ, 44-310 IU/mL] to 16 IU/mL [IQ, 14-64 IU/mL]; P =.008); UPSIT (11 [IQ, 9-24] to 32 [IQ, 26-33]; P =.038); and urinary LTE4 (258 IU/mL [IQ, 146-288 IU/mL] to 100 IU/mL [IQ, 63-107 IU/mL]; P =.021).

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

Reference

Mustafa S, Vadamalai K, Scott B, Ramsey A. Dupilumab as add-on therapy for aspirin-exacerbated respiratory disease (AERD). J Allergy Clin Immunol. 2020;145(Suppl 2):AB173.

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This article originally appeared on Pulmonology Advisor