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Bacharier LB, Guilbert TW, Katelaris CH, Deschildre A, Phipatanakul W, Liu D, Altincatal A, Mannent LP, Amin N, Laws E, Akinlade B, Jacob-Nara JA, Deniz Y, Rowe PJ, Lederer DJ, Hardin M. Dupilumab Improves Lung Function Parameters in Pediatric Type 2 Asthma: VOYAGE Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:948-959. [PMID: 38092225 DOI: 10.1016/j.jaip.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Uncontrolled asthma in growing children can impair lung growth that may lead to adverse complications in later life. Dupilumab, a human monoclonal antibody, blocks the shared receptor for IL-4 and IL-13, key drivers of type 2 inflammation. OBJECTIVE To extensively evaluate the effect of dupilumab on lung function in children (6-11 years) with moderate-to-severe asthma enrolled in phase 3 LIBERTY ASTHMA VOYAGE (NCT02948959). METHODS Children with asthma were randomized 2:1 to add-on dupilumab 100/200 mg by bodyweight or placebo every 2 weeks, for 52 weeks. We analyzed spirometry parameters in children with type 2 asthma (blood eosinophils ≥150 cells/μL or fractional exhaled nitric oxide [FeNO] ≥20 parts per billion [ppb] at baseline) and within subgroups defined by baseline blood eosinophils or FeNO values. RESULTS A total of 116 (49%) dupilumab-treated children and 59 (52%) on placebo had impaired lung function (prebronchodilator percent-predicted forced expiratory volume in 1 second [ppFEV1] <80%) at baseline. Dupilumab improved pre- and postbronchodilator ppFEV1 as early as week 2, sustained for up to 52 weeks (least-squares mean difference vs placebo at week 52: 7.79 percentage points; 95% confidence interval [CI]: 4.36-11.22; P < .001 and 4.37 points; 95% CI: 0.95-7.78; P = .01, respectively). Sustained improvements were also observed in other lung function parameters, including pre- and postbronchodilator forced vital capacity (FVC), prebronchodilator forced expiratory flow, and FEV1/FVC ratio across all populations. CONCLUSIONS Dupilumab led to significant, sustained lung function improvements across a range of lung function measures in children (6-11 years) with uncontrolled, moderate-to-severe type 2 asthma.
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Affiliation(s)
- Leonard B Bacharier
- Division of Allergy, Immunology and Pulmonary Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn.
| | - Theresa W Guilbert
- Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, Ohio
| | - Constance H Katelaris
- Campbelltown Hospital, Campbelltown, NSW, Australia; Western Sydney University, Sydney, NSW, Australia
| | - Antoine Deschildre
- CHU Lille, Lille University Hospital, Lille, France; Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre Hospital, Lille, France
| | - Wanda Phipatanakul
- Department of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Dongfang Liu
- Department of Immunology, Sanofi, Beijing, China
| | | | | | - Nikhil Amin
- Department of Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY
| | | | - Bolanle Akinlade
- Department of Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY
| | - Juby A Jacob-Nara
- Department of Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY
| | - Yamo Deniz
- Department of Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY
| | - Paul J Rowe
- Department of Immunology, Sanofi, Bridgewater, NJ
| | - David J Lederer
- Department of Medical Affairs, Regeneron Pharmaceuticals Inc., Tarrytown, NY
| | - Megan Hardin
- Department of Immunology, Sanofi, Cambridge, Mass
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Korn S, Schmidt O, Timmermann H, Watz H, Gappa M, Radwan A, De Prado Gómez L, Atenhan A, Barbus S, Thakur M, Lommatzsch M. Real-World Characteristics of Patients with Severe Asthma prior to Starting Dupilumab: The ProVENT Study. Respiration 2023; 103:10-21. [PMID: 38086344 PMCID: PMC10823561 DOI: 10.1159/000535390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/17/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Dupilumab is approved for the treatment of severe type 2 (T2) asthma; however, the characteristics of patients receiving dupilumab in routine clinical practice are incompletely understood. This study describes the characteristics of patients with severe asthma before dupilumab treatment in a real-world setting. METHODS This interim analysis of an ongoing real-life study of dupilumab assessed baseline characteristics of the first patient cohort enrolled in the ProVENT study. RESULTS A total of 99 patients (59% females) were analyzed (17% received another biologic before dupilumab treatment and 15% were on maintenance oral corticosteroid treatment). Adult-onset asthma (>18 years) and an allergic phenotype were documented in 58% and 48% of patients, respectively. Median (interquartile range) age was 54 (40-61) years; the median number of exacerbations in the last 24 months was 1 (0-3); median fractional exhaled nitric oxide (FeNO) value was 38 (23-64) ppb; and median blood eosinophils (bEOS) count was 184 (8-505) cells/µL. According to the United Kingdom Severe Asthma Registry classification, 53% of patients had T2 intermediate asthma (bEOS ≥150 cells/µL or FeNO ≥25 ppb), 17% had T2 high asthma (bEOS ≥150 cells/µL and FeNO ≥25 ppb), and 4% had T2 low asthma (bEOS <150 cells/µL and FeNO <25 ppb). At least one GINA criterion for T2 airway inflammation was documented in 70% of patients. T2 comorbidities were observed in 64% of patients. CONCLUSIONS This analysis suggests that patients eligible for dupilumab treatment display various clinical and biochemical characteristics rather than one clear-cut phenotype.
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Affiliation(s)
- Stephanie Korn
- Clinical Research Centre, Respiratory Medicine, IKF Pneumologie Mainz, and Thoraxklinik Heidelberg, Heidelberg, Germany
| | - Olaf Schmidt
- Internal Medicine and Pneumology, Lungen- und Bronchialheilkunde, Koblenz, Germany
| | - Hartmut Timmermann
- Internal Medicine, Allergologie, Lungen- und Bronchialheilkunde, Hamburg, Germany
| | - Henrik Watz
- Pulmonary Research Institute, LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Monika Gappa
- Children's Hospital, Evangelisches Krankenhaus Düsseldorf, Dusseldorf, Germany
| | - Amr Radwan
- Global Clinical Development, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | | | | | | | - Marek Lommatzsch
- Department of Pneumology, University of Rostock, Rostock, Germany
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