Updated Evaluation of Dupilumab in the Treatment of Asthma: Patient Selection and Reported Outcomes

Figures & data

Figure 1 Asthma related actions of interleukin-4 and interleukin-13.

Abbreviations: IL-4, interleukin-4; IL-13, interleukin-13; IL-5, interleukin-5; IgE, immunoglobulin E; Th2, T helper 2.

Table 1 Inclusion Characteristics of Patients in Dupilumab Studies

Baseline Characteristics	Considerations
Failing > 500 µg of fluticasone propionate	Inclusion criterion for all of the phase 3 asthma trials
Failing an additional controller medication	Inclusion criterion for all of the phase 3 asthma trials
12% reversibility in FEV1 at baseline	Inclusion criterion for moderate-to-severe trials
Asthma Control Questionnaire > 1.5	Inclusion criterion for moderate-to-severe trials
Oral glucocorticoid dependent asthma	Inclusion criteria for severe steroid dependent trial

Abbreviation: FEV₁, forced expiratory volume in one second.

Table 2 Baseline Characteristics Favoring Response in Dupilumab Studies

Baseline Characteristics	Rationale	Other Considerations
Blood eosinophil count > 300 cells/mm^3	Greatest reduction in asthma exacerbations happened in this cohort	Elevations of eosinophil count above 3000 cells/mm^3 in 1.2% of patients on dupilumab
Blood eosinophil count > 150 cells/mm^3	Asthma exacerbations and FEV1 were not better than placebo with eosinophils < 150 cells/mm^3
FENO > 25 ppb	Asthma exacerbations and FEV1 were not better than placebo with lower FENO

Abbreviations: FE_NO, fractional exhaled nitric oxide; FEV₁, forced expiratory volume in one second; ppb, parts per billion.

Table 3 Using Dupilumab in the Presence of Specific Comorbid Diseases

Comorbid Disease	Rationale	Other Considerations
Atopic dermatitis	35–40% of patients had significant improvement in symptoms of pruritus	Conjunctival or other eye side effects appeared more often in studies of atopic dermatitis
Chronic rhinosinusitis with nasal polyps	Nasal polyps reduced in size and nasal symptom scores improved	FEV1 and asthma control improved in these patients
Allergic rhinitis	Allergic rhinitis symptoms improved	Studies were from post-hoc analyses
Hypereosinophilic syndrome Chronic eosinophilic pneumonia (Caution, consider avoiding)	Eosinophils were increased during treatment	Severe adverse event of worsening chronic eosinophilic pneumonia reported

Abbreviation: FEV₁, forced expiratory volume in one second.