7 June 2018

Eczema biologic can also treat severe asthma

Clinical Drugs Research Respiratory

A biologic currently registered as an eczema treatment in Australia has been shown to lower the rate of asthma attacks, suggesting that monoclonal antibodies may play a greater role in asthma treatment in the future.

Dupixent (dupilumab) was registered in Australia in January as the first targeted biologic for adults with severe atopic dermatitis.

Now, two studies published in the New England Journal of Medicine show that dupilumab is also an effective and safe treatment for severe asthma.

In the first study, around 2,000 patients aged over 12 years with uncontrolled moderate-to-severe asthma were randomly assigned fortnightly subcutaneous injections of dupilumab or  placebo for one year.

Some patients were given a 200mg dose, and others were given a 300mg dose. Patients continued taking their normal asthma medications during the trial.

The group of patients taking either dose of dupilumab had around half the placebo group’s rate of asthma exacerbations, with similar rates of adverse effects.

Dupilumab also boosted lung function; the FEV1 was 0.14 litres higher in the dupilumab group compared with the placebo group at 12 weeks.

Dupilumab had greater benefits in patients with higher baseline levels of eosinophils, who were more likely to have asthma caused by type 2 inflammation, which was disrupted by dupilumab.

The second study showed that dupilumab also reduced the need for oral steroids. Around 200 patients who took oral glucocorticoids for their asthma were given either dupilumab or a placebo add-on fortnightly for six months.

Patients taking dupilumab were able to reduce their use of oral glucocorticoids more than the placebo group, while also decreasing their rate of severe exacerbations and increasing their lung function.

Around half of patients on dupilumab stopped using oral glucocorticoids altogether, compared with 25% in the placebo group.

Monoclonal antibodies were promising treatments because they specifically targeted different types of inflammation causing asthma, Dr Jonathan Burdon, the chair of National Asthma Council Australia, said.

“Monoclonal antibodies are where we are going with severe asthma,” he said.

A spokesperson at Sanofi, the manufacturer of dupilumab, said the company was unable to speculate about the timelines for using dupilumab for asthma treatment.

Dupilumab for eczema was not PBS listed and was not yet commercially available in Australia, the spokesperson said.

However, there is currently one monoclonal antibody listed on the PBS for asthma, Xolair (omalizumab). This drug is given as a subcutaneous injection. It works by capturing IgE, an antibody, which helps produce an inflammatory response to allergens.

It was quite an expensive medication, and the PBS funding was therefore limited to a small number of patients, Dr Burdon said.

To access Xolair, patients must be aged six to 12 years with poorly controlled, severe allergic asthma. They must also have documented exacerbations despite daily high-dose inhaled corticosteroids, and have IgE levels within a certain range.

NEJM 2018, 21 May