Dupilumab: A New Option for Severe Asthma

Abstract

Pathophysiology of severe asthma is complicated. Several biologic agents targeting cytokines involved in type 2 inflammation have been approved for the treatment of uncontrolled severe asthma based on phenotype. Dupilumab, an interleukin-4 receptor antagonist, is a human monoclonal antibody that specifically binds to the interleukin-4Rα receptor alpha subunit, thus inhibits the dual signaling pathways of both interleukin-4 and interleukin-13 which are associated with inflammation in many chronic upper and lower respiratory tract diseases. The drug is recommended as an add-on agent for long-term treatment in patients, 12 years of age and older, who suffer from moderate-to-severe asthma from type 2 inflammation caused by the eosinophilic phenotype. According to a pool analysis of efficacy trials, dupilumab significantly reduced severe exacerbations in one year and was better for asthma control over placebo. This agent also improved lung function, particularly in patients with blood eosinophil count above 150 cells/microliter or exhaled nitric oxide level above 25 parts per billion. In addition, it improved quality of life while decreasing the need for oral glucocorticoid use. Injection-site reactions and hypereosinophilia were the most common adverse effects of dupilumab. Pharmacoeconomic analysis showed that dupilumab was cost-effective as an add-on agent for maintenance therapy in adult patients with refractory eosinophilic asthma.