Dupilumab Plus House Dust Mite Sublingual Immunotherapy For Allergic Asthma

Among patients with house dust mite (HDM)-related asthma and allergic rhinitis, HDM sublingual immunotherapy (SLIT) combined with dupilumab treatment may improve asthma control, according to study findings published recently in Allergology International.

Researchers sought to evaluate the efficacy of HDM SLIT in combination with dupilumab in controlling asthma in a real-world setting. They also examined how this combined therapy affected inflammation and airway remodeling.

The investigators conducted an observational analysis, adding HDM SLIT to the treatment regimen of 47 adult patients with asthma with rhinitis being treated with dupilumab (mean treatment duration 12.6±4.1 months) whose asthma was not fully controlled with this therapy (mean age 58±7 years; mean disease duration 23±16 years; 19/47 patients were male). A total of 41 patients completed the study.

At baseline and again at 48 weeks after treatment, investigators administered the asthma control questionnaire (ACQ)-5, and asthma quality of life questionnaire (AQLQ) to study enrollees as measures of the study’s primary endpoints. Secondary study endpoints were the rhinoconjunctivitis quality of life questionnaire (RQLQ), along with spirometry and tomographic measurements. Of the patients completing the study, 70% (29/41) were deemed to have responded to the addition of SLIT to dupilumab.

Overall, researchers found that the combined treatment improved ACQ-5, AQLQ, and RQLQ scores, reduced fractional exhaled nitric oxide (FENO), airway percentage wall area, and wall thickness, and increased lung function (all P <.05). Changes in AQLQ and ACQ-5 scores correlated with changes in FENO and forced expiratory volume in 1 second (FEV₁) percent predicted, and the FEV₁ percent predicted was an independent factor of AQLQ improvement (r²=0.510; P =.012). Researchers noted that the baseline area under the curves in FEV₁ percent predicted, total IgE, and serum HDM specific-IgE was high (>0.8).

In comparing baseline characteristics between those who responded to HDM SLIT and those who did not, the researchers found that “treatment was significantly more effective in patients with higher value of serum s-IgE, FEV₁ percent predicted and less symptoms of asthma,” and that “combining the biomarkers of HDM s-IgE and FEV1 was by far the strongest predictor of successful [response].”

The investigators concluded that, “These results support the benefits of adding HDM SLIT to pharmacotherapy plus dupilumab in uncontrolled asthma with rhinitis.” Study limitations include the single arm design, underpowered sample size, short treatment duration, and lack of asthma exacerbation assessment.

Reference

Hoshino M, Akitsu K, Kubota K, Ohtawa J. Efficacy of a house dust mite sublingual immunotherapy tablet as add-on dupilumab in asthma with rhinitis. Allergol Int. Published online June 16, 2022. doi:10.1016/j.alit.2022.05.010