Preclinical and clinical experience with dupilumab on the correlates of live attenuated vaccines

Background

The safety and tolerability of live attenuated vaccines in patients administered dupilumab for moderate-to-severe asthma have not been previously evaluated. During the LIBERTY ASTHMA TRAVERSE open-label extension study (ClinicalTrials.gov identifier NCT02134028), a yellow fever outbreak in Brazil required administration of a live attenuated vaccine to at-risk individuals.

Objective

Our aim was to evaluate immune response to a live attenuated vaccine in the context of IL-4 receptor blockade (REGN1103, a dupilumab surrogate) in mice and in dupilumab-treated patients with moderate-to-severe asthma who participated in TRAVERSE.

Methods

In the preclinical study, mice were coadministered REGN1103/isotype control and live attenuated influenza vaccine/control, followed by influenza virus challenge. During TRAVERSE, 37 patients discontinued dupilumab treatment and were administered 17D live attenuated yellow fever vaccine (YFV). Safety and tolerability data, dupilumab serum concentrations, and plaque reduction neutralization titers before and after vaccination were collected.

Results

In the preclinical study, there was no impact of REGN1103 on vaccine efficacy in mice. In TRAVERSE, all 37 patients who received YFV achieved seroprotection despite most having therapeutic levels of dupilumab, with the magnitude of response appearing unrelated to prevaccination dupilumab concentrations. No instances of vaccine-related adverse events or vaccine hypersensitivity were reported in 36 patients; 1 patient reported nonserious body ache, malaise, and dizziness 7 days after vaccination but recovered fully.

Conclusion

The preclinical model suggested that dupilumab does not affect the efficacy of live attenuated influenza vaccine. The live attenuated YFV did not raise safety concerns and appeared to be well tolerated in patients with asthma who recently discontinued dupilumab treatment, and dupilumab concentrations had no apparent impact on immunologic response to the vaccine.

Laboratory Safety of Dupilumab in Patients Aged 6-11 Years with Severe Atopic Dermatitis: Results from a Phase III Clinical Trial

BACKGROUND

Previous studies of dupilumab in adolescents and adults with moderate-to-severe atopic dermatitis (AD) showed no clinically meaningful adverse changes in laboratory parameters.

OBJECTIVE

The aim of this study was to assess laboratory outcomes in children aged 6-11 years with severe AD in a randomized, placebo-controlled, phase III trial of dupilumab.

METHODS

Children aged 6-11 years with severe AD were randomized 1:1:1 to 16 weeks of dupilumab 300 mg every 4 weeks, 100 or 200 mg every 2 weeks, or matching placebo, all with concomitant topical corticosteroids (TCS). Blood samples were collected at baseline and Weeks 4, 8, and 16; urine samples were collected at baseline and Weeks 4 and 16.

RESULTS

Of 367 patients enrolled in the study, 362 were included in the safety analysis, 351 completed study treatment, and 4 withdrew due to treatment-emergent adverse events not related to laboratory abnormalities. Both dupilumab + TCS groups showed overall trends toward increases in mean blood levels of eosinophils and alkaline phosphatase, and decreases in mean blood levels of platelets, neutrophils, and lactate dehydrogenase levels, without corresponding mean changes in the placebo + TCS group. None of these changes were associated with symptoms or clinically meaningful adverse outcomes, and none led to treatment modification. No clinically significant changes or trends were observed for other measured laboratory parameters.

CONCLUSION

There were no clinically meaningful adverse changes in routine laboratory parameters attributable to treatment with dupilumab + TCS. Changes in platelet counts and lactate dehydrogenase levels likely reflect reduced inflammation. These results confirm similar findings in adults and adolescents, and suggest that there is no need for routine laboratory monitoring of children aged 6-11 years treated with dupilumab + TCS for severe AD.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03345914. Does treatment with dupilumab require routine laboratory monitoring in 6- to 11-year-old children with severe atopic dermatitis? (MP4 180482 kb).

Distinct roles of STAT4α and STAT4β in the pathogenesis of experimental allergic encephalomyelitis (B99)

Experimental allergic encephalomyelitis (EAE) is a T cell-mediated autoimmune disease model of multiple sclerosis (MS). Interleukin 12 (IL-12) and IL-23 are heterodimeric cytokines, which share common IL-12p40/IL-12Rb2 subunits and play distinct roles in the pathogenesis of EAE. Signaling through JAK-STAT pathway, IL-12 induces Th1 cell development, while IL-23 enhances ThIL17 cell differentiation. We and other have shown earlier that therapeutic intervention or targeted disruption of STAT4 was effective in ameliorating EAE. Recent studies have identified the expression of a full-length STAT4α and a truncated STAT4β, which lacks 44 amino acids at the C-terminus. In this study we show that the STAT4β transgenic mice, induced to develop EAE by immunization with MOGp35-55 peptide, develop an exacerbated EAE than the wild type littermates. However, the STAT4α transgenic mice remain resistant to EAE, as seen in STAT4 knockout mice. Further analyses, by real-time PCR, ELISA and Western blot, show that STAT4β transgenic mice express higher levels of IFNγ, IL-17, IL-12, IL-23 and IL-27 in the brain and spleen than STAT4α transgenic mice, which correlates with the clinical outcome of EAE. Although the distinct roles played by STAT4α and STAT4β in IL-12 and IL-23 signaling in EAE is not known, this study validates the use of STAT4β as a novel therapeutic target in the treatment of MS and other autoimmune diseases.