Dupilumab linked to fewer respiratory infections from asthma and chronic rhinosinusitis

January 28, 2022

2 minute read


Disclosures: Geng reports fees from GlaxoSmithKline, Optinose, Pfizer, Regeneron Pharmaceuticals and Sanofi; AstraZeneca and Pfizer consultant fees; and a research grant from Genentech. Please see the study for relevant financial information from all other authors.

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According to data published in Jhe Journal of Allergy and Clinical Immunology: In practice.

“The common pathophysiology of asthma and CRSwNP has important implications for their diagnosis and management, especially since they often occur together,” Bob gengMD, allergist and immunologist at Rady Children’s Hospital in San Diego and assistant clinical professor at the University of California, San Diego School of Medicine, and colleagues wrote. “This provides a compelling rationale for treatments directed at the underlying systemic inflammation in patients with either condition.”

Data are from Geng B, et al. J Allergy Clin Immunol Convenient. 2021; doi:10.1016/j.jaip.2021.12.006.

The researchers performed a post-hoc retrospective analysis of the LIBERTY ASTHMA QUEST study, which included 1,897 moderate to severe asthma patients treated with dupilumab (Dupixent; Sanofi, Regeneron; n=1,263) or placebo (n=634) , and the LIBERTY NP SINUS-52 study, which included 447 patients with severe CRSwNP treated with dupilumab (n=297) or placebo (n=150).

In the QUEST study, patients treated with dupilumab had fewer respiratory tract infections (103.34 versus 113.08 events per 100 person-years; RR=0.78; 95% CI, 0.71-0 .85), according to investigator reports. Patients treated with dupilumab also had fewer upper (RR=0.77; 95% CI, 0.7-0.85) and lower (RR=0.72; 95% CI, 0.72) respiratory tract infections. .59-0.87) reported by the investigator compared to controls.

The researchers found similar results in patients enrolled in the SINUS-52 study. Patients treated with dupilumab were less likely to have respiratory tract infection events than controls (69.13 versus 111.68 per 100 person-years; RR = 0.62; 95% CI 0.51 -0.75), and they showed a 34% (RR=0.66; 95% CI, 0.53-0.81) lower event rate of upper respiratory tract infections and 49% (RR= 0.51; 95% CI, 0.3-0.86) lower rate of lower respiratory tract infection events.

In patients with asthma, dupilumab significantly reduced the annualized rate of severe exacerbations compared to placebo, both in patients who had respiratory infections and in those who did not (P

For patients with CRSwNP, dupilumab reduced the proportion of patients requiring oral corticosteroids (OCS) to treat disease flares or symptoms compared to the placebo group (13.2% vs. 41.2%).

“The reduction in investigator-reported infections during treatment may have contributed to the reduction in exacerbations and the corresponding decrease in the need for OCS observed in dupilumab-treated patients,” Geng and colleagues wrote. “Alternatively, since corticosteroid use is a known risk factor for infections, reducing OCS use in patients treated with dupilumab compared to placebo could lead to a reduction in respiratory infections.”

The researchers noted the retrospective nature of the study as a limitation, as well as the presence of investigator-reported respiratory infections not necessarily supported by accompanying laboratory data.

They also noted that because allergic rhinitis is often mistaken for a sinus infection, it’s possible that allergic flare-ups in patients with CRSwNP were misclassified as respiratory infections.

“The exact mechanisms underlying the investigator-reported reduced rate of respiratory infections observed in dupilumab-treated patients is an important area for future investigation,” the researchers concluded.

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