Real-world effectiveness and predictors of super-responders to dupilumab in a Chinese uncontrolled asthma cohort
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Published:2024-01-01
Issue:1
Volume:45
Page:e14-e22
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ISSN:1088-5412
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Container-title:Allergy and Asthma Proceedings
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language:en
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Short-container-title:allergy asthma proc
Author:
Chen Xiaoying1, Luo Huiting1, Yan Wenbo1, Tang Kailun1, Huang Junfeng1, Xie Shuojia2, Lin Zhenxuan1, Zhang Zhenle2, Shi Xu3, Xian Mo3, Wang Wanjun1, Li Jing3, Chen Ruchong1
Affiliation:
1. From the State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health; Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou
Medical University, Guangzhou, Guangdong, China 2. College of Clinical Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China, and 3. From the State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health; Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical
University, Guangzhou, Guangdong, China
Abstract
Background: Dupilumab has been shown to be effective in clinical trials for moderate-to-severe uncontrolled asthma. However, the efficacy of dupilumab in the real world and the prediction of treatment response have not been well studied in patients with asthma. Objective:
To investigate the efficacy of dupilumab and explore predictors of super-responders in a Chinese retrospective cohort. Methods: From January 2021 through December 2022, the patients with uncontrolled asthma who were treated with dupilumab for 4 months were included.
Symptom control, type 2 inflammatory biomarkers, and lung function were collected at baseline and follow-up for efficacy assessment. Super-responders were defined as exacerbation-free, off maintenance of oral corticosteroids (mOCS), and with a score of the five-item Asthma Control Questionnaire
(ACQ-5) of <0.5. The uni- and multivariable logistic regressions were used to construct predictive models for super-responders based on baseline features. Results: A total of 53 patients were included. After 4 months treatment, the median (interquartile range [IQR])
ACQ-5 score decreased from 1.8 (1.6‐2.4) to 0.4 (0.2‐0.8) (p < 0.001), the median (IQR) number of exacerbations, from 0.0 (0.0‐1.0) to 0.0 (0.0-0.0) (p = 0.005). The median (IQR) dose of mOCS (prednisone equivalent) decreased from 15.0 mg/day (8.8‐22.5 mg/day)
to 2.5 mg/day (0.0‐10.0 mg/day) (p = 0.008) in nine patients who were receiving mOCS. All efficacy assessment parameters, including sputum eosinophil were significantly improved, while blood eosinophil count did not decline (530 cells/mm3 [300‐815 cells/mm3]
versus 560 cells/mm3 [220‐938 cells/mm3], p = 0.710). After taking dupilumab, 25 of 53 patients (47.2%) achieved a super-response. The age of onset < 42 years (odds ratio [OR] 7.471 [95% confidence interval {CI}, 1.286‐43.394) and the baseline fractional
exhaled nitric oxide (FeNO) of 25‐50 ppb (OR 35.038 [95% CI, 3.104‐395.553]) predicted super-responders, which showed a C-index of 0.822 (95% CI, 0.697‐0.947). Conclusion: Dupilumab significantly improved symptom control, type 2 inflammatory markers,
and lung function in Chinese patients with uncontrolled asthma. Airway eosinophils, rather than blood eosinophils, can be a reliable indicator of therapeutic efficacy. The early-onset asthma as well as the medium-high level of baseline FeNO contributed to the prediction of super-responders.
Publisher
Oceanside Publications Inc.
Subject
Pulmonary and Respiratory Medicine,General Medicine,Immunology and Allergy
Reference35 articles.
1. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015;Lancet Respir Med,2017 2. Global Strategy for Asthma Management and Prevention, 2020 3. Dupilumab in persistent asthma with elevated eosinophil levels;Wenzel;N Engl J Med,2013 4. Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma;Castro;N Engl J Med,2018 5. Efficacy and safety of dupilumab in glucocorticoid-dependent severe asthma;Rabe;N Engl J Med,2018
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