Eczema Drug 'Dupilumab' can relieve Asthma Symptoms

Dupilumab, an FDA approved eczema drug was surprisingly found to relieve severe asthma attacks, finds a new study. Two new studies have shown that the eczema drug can, in fact, relieve symptoms in difficult-to-control asthma cases. The findings of this study are published in the The New England Journal of Medicine. Dupilumab was approved only last year to treat eczema, it is an injectable anti-inflammatory drug.

More than two thousand patients were involved in this study and all of these patients had a moderate to severe asthma. All of them were on asthma treatments and used to take asthma inhalers, and some even took oral steroids to control their severe asthma symptoms.

In the first study, asthma exacerbation rates reduced by a half in patients who were taking Dupilumab compared to those who were on placebo. On an average, one exacerbation was observed every day in the group taking placebos.

Exacerbations as such are nothing but periods of asthma symptoms such as coughing, shortness of breath, tightness in the chest and wheezing.

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Another new insight was found in this particular study, Dupilumab was found to work extremely well in patients who had high numbers of eosinophils (a type of white blood cell) circulating in the bloodstream. Asthma exacerbations were cut in half in these patients.

Mario Castro, an author of this study said: “This drug not only reduced severe symptoms of asthma, it improved the ability to breathe,”. He also added that "That’s important because these patients have a chronic disabling disease that worsens over time with loss of lung function. So far, we do not have a drug for asthma that changes the course of the disease. Current drugs for severe asthma help reduce trips to the emergency room, for example, but they don’t improve lung function."

Comparison Between Two Studies

Nearly 1,900 patients were included in the first study. Most of them had moderate to severe asthma which required them to take at least three different inhalers to control their symptoms.

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For the study, they took three inhalers in which one of them contained corticosteroids, the second one had a long-acting bronchodilator drug and whereas the third one had albuterol, a short-acting bronchodilator otherwise called as "rescue" inhaler.

Patients who were on these drug filled asthma pumps were assigned dupilumab or a placebo randomly for over a year. The patients who were on dupilumab were also given higher or lower dose of the drug randomly. Doctors or the patients also did not know what they were receiving (I.e the drug or the placebo).

At the very end, they also found that patients on dupilumab had an improvement in their lung function. After taking the drug patient’s lung function improved by 130-200 milliliters according to a “forced expiratory volume” test. No significant difference was observed in patients receiving a high dose or lower dose.

Hospitalization and Emergency Room (ER) visits also decreased. Another benefit was found, while doing a second study. Castro found that this drug could also be used to wean people off certain chronic oral steroids. These steroids are well known to cause debilitating long-term side effects such as stunted growth, diabetes, cataracts and osteoporosis.

Nearly 200 patients having the same inhaled asthma medications were enrolled in the study. Half of the people who were subjected to receive dupilumab were able to say no to the use of prednisone and even 80% of dupilumab-treated patients were able to cut their dose in half.

Patients who were receiving placebo also showed a decrease in prednisone use but to a minimum.

The lead author has explained the possible uses of this drug in asthma treatment. This drug can help doctors make patients less reliant on steroids for their asthma control.

"I have patients who have had to stop working and go on disability because their asthma symptoms are so severe they can no longer function in the workplace," Castro said. "I’m excited about the potential of dupilumab because I have so many patients who have maxed out on available therapies and they still can’t breathe. It can become a very disabling disease."

During the study, a few side effects were also noted such as pain at the injection site, a small bump in the number of eosinophils. Causalities were also reported during the study, as five people receiving the drug and 3 people taking placebo died. None of the deaths were deemed to be related to the study protocol and had occurred because of patients’ previous medical conditions say the investigators in charge.

Reference:

1. Mario Castro, M.D., Jonathan Corren, M.D., Ian D. Pavord, M.D., Jorge Maspero, M.D., Sally Wenzel, M.D., Klaus F. Rabe, M.D., William W. Busse, M.D., Linda Ford, M.D., Lawrence Sher, M.D., J. Mark FitzGerald, M.D., Constance Katelaris, M.D., Yuji Tohda, M.D., et al. "Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma", New England Journal of Medicinel (2018). DOI: 10.1056/NEJMoa1804092

Source-Medindia