Early responders within seven days of dupilumab treatment for severe asthma evaluated by patient-reported outcome: a pilot study

  • Nozomi Tani Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
  • Nobutaka Kataoka Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
  • Yusuke Kunimatsu Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan. https://orcid.org/0000-0002-8667-8044
  • Yusuke Tachibana Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
  • Takumi Sugimoto Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
  • Izumi Sato Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
  • Yuri Ogura Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
  • Kazuki Hirose Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
  • Takayuki Takeda | dyckw344@yahoo.co.jp Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan. https://orcid.org/0000-0002-8375-6940

Abstract

Background: The management of severe asthma-associated symptoms is essential since they are distressing to the affected patients, and also greatly impair their quality of life. Dupilumab, a monoclonal antibody, blocks interleukin (IL)-4 and IL-13 signaling, both of which are crucial in acquired and innate immunity pathways through fast signal transduction, leading to an early response to treatment. Although rapid improvement within 1–3 days after dupilumab treatment was observed in moderate-to-severe atopic dermatitis, an early response within 7 days of dupilumab treatment in severe asthma has not been reported. 
Methods: Twelve consecutive patients with severe asthma who were newly treated with dupilumab between July 2019 and April 2020 were retrospectively investigated. We evaluated the early response (within 7 days) of patients with severe asthma receiving dupilumab therapy. Asthma control test (ACT) and the daily ACT, which was modified from the ACT to evaluate daily symptoms associated with asthma, were adopted as patient-reported outcomes (PROs) at week 8 and within 7 days, respectively. Patients were stratified into early responders (7 days), late responders (week 8), and non-responders without significant improvement in PROs. Descriptive statistics were adopted due to the limited number of patients.
Results: Four of these 12 patients were early responders, with the following baseline characteristics: body mass index, <25 kg/m2; without depression; baseline forced expiratory volume in 1 second, <1.50 L; and more than one exacerbation in 1 year. On the other hand, five were late responders, and 44.4% of the nine responders were early responders. The higher the eosinophilic count and/or FeNO did not show any relationship between the early responder and nonresponder.
Conclusions: The effect of dupilumab on severe asthma in patients with atopic features could be started earlier than 2 weeks, similar to atopic dermatitis. Daily ACT may be useful in monitoring the early efficacy of dupilumab in treating severe asthma.

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Published
2021-03-17
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Original Research Articles
Conflict of interest statement
The authors declare that they have no competing interests, and all authors confirm accuracy
Keywords:
Asthma, daily ACT (asthma control test), dupilumab, early responder, severe asthma, quality of life
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How to Cite
Tani, N., Kataoka, N., Kunimatsu, Y., Tachibana, Y., Sugimoto, T., Sato, I., Ogura, Y., Hirose, K., & Takeda, T. (2021). Early responders within seven days of dupilumab treatment for severe asthma evaluated by patient-reported outcome: a pilot study. Multidisciplinary Respiratory Medicine, 16. https://doi.org/10.4081/mrm.2021.736