Short-Term Evaluation of Dupilumab Effects in Patients with Severe Asthma and Nasal Polyposis
Corrado Pelaia, Nicola Lombardo, Maria Teresa Busceti, Giovanna Lucia Piazzetta, Claudia Crimi, Cecilia Calabrese, Alessandro Vatrella, Girolamo Pelaia
Abstract
Background: Having been approved for biological treatment of atopic dermatitis, dupilumab has also been recently licensed as add-on therapy for severe asthma and nasal polyposis. With regard to the latter diseases, few real-life clinical investigations have been carried out to date. Objective: The primary end point of this single-center observational study was to evaluate in a real-life setting the short-term therapeutic effects of dupilumab in patients with severe asthma and nasal polyposis. Methods: At baseline and after 4 weeks of add-on therapy with dupilumab, several clinical and functional parameters were assessed in 20 patients with severe asthma and nasal polyposis, including both allergic and nonallergic subjects. Results: After 4 weeks of treatment with dupilumab, all patients experienced remarkable improvement in both severe asthma and nasal polyposis. In particular, asthma-control test and sinonasal outcome test 22 scores had significantly increased ( p < 0.0001) and decreased ( p < 0.0001), respectively. Oral corticosteroid intake got to zero within 4 weeks ( p < 0.0001). Moreover, in week 4, significant increases were detected with regard to both prebronchodilator forced expiratory volume in the first second ( p < 0.01) and forced vital capacity (FVC; p < 0.05). At the same time point, dupilumab had significantly reduced residual volume ( p < 0.0001) and total lung capacity ( p < 0.001), whereas it had enhanced forced midexpiratory flow of 25%– 75% FVC ( p < 0.01) and peak expiratory flow ( p < 0.01). After 4 weeks of treatment, dupilumab had also lowered levels of fractional exhaled nitric oxide ( p < 0.0001). Conclusion: The results of this real-life study suggest that dupilumab can be utilized in both allergic and nonallergic patients with severe asthma and nasal polyposis as a valuable add-on biological therapy with rapid onset of action. Keywords: severe asthma, nasal polyposis, interleukin 4 receptor, dupilumab