Dupilumab Plus Sublingual house dust mite immunotherapy for allergic asthma

According to the results of a study recently published in International Allergology.

The researchers sought to assess the effectiveness of HDM SLIT in combination with dupilumab in controlling asthma in a real-world setting. They also looked at how this combination therapy affected airway inflammation and remodeling.

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


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At baseline and again 48 weeks after treatment, researchers administered the Asthma Control Questionnaire (ACQ)-5 and the Asthma Quality of Life Questionnaire (AQLQ) to study participants. as measures of the study’s primary endpoints. The secondary endpoints of the study were the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), as well as spirometry and tomographic measurements. Of the patients who completed the study, 70% (29/41) were considered to have responded to the addition of SLIT to dupilumab.

Overall, the researchers found that the combination treatment improved ACQ-5, AQLQ, and RQLQ scores, reduced fractionated exhaled nitric oxide (FENO), airway wall percentage and wall thickness, and increased lung function (all P <.05 changes in aqlq and acq-5 scores are correlated with feno forced expiratory volume second>1) percent predicted, and the FEV11 the predicted percentage was an independent factor of improvement in the AQLQ (r2=0.510; P =.012). The researchers noted that the reference area under the FEV curves1 percent predicted, total IgE and serum HDM-specific IgE were elevated (>0.8).

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 serum s-IgE value, FEB1 predicted percentage and fewer asthma symptoms“, and that “the combination of HDM s-IgE and FEV1 biomarkers was by far the best predictor of success [response].”

The researchers concluded that “these results support the benefits of adding HDM SLIT to pharmacotherapy plus dupilumab in uncontrolled asthma with rhinitis.” Limitations of the study include single-arm design, insufficient sample size, short duration of treatment, and lack of assessment of asthma exacerbation.

Reference

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

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