Dupilumab, a fully human anti-IL-4Rα mAb, inhibits signaling of IL-4 and IL-13, key drivers of type 2/Th2 immune diseases. Dupilumab is approved by the FDA with or without topical corticosteroids for treatment of adults with moderate-to-severe AD. We report on efficacy and safety of dupilumab in adults with moderate-to-severe AD with or without comorbid patient-reported asthma in two pooled phase 3 monotherapy trials (LIBERTY AD SOLO 1&2: NCT02277743; NCT02277769).
Patients were randomized (1:1:1) to subcutaneous dupilumab 300mg every 2 weeks (q2w; n=457) or weekly (qw; n=462), or placebo (n=460) for 16 weeks. Endpoints included proportion of patients with Investigator’s Global Assessment (IGA) 0/1, ≥75% improvement in Eczema Area and Severity Index (EASI-75), and peak pruritus Numerical Rating Scale (NRS) improvement ≥4. Safety was assessed.
Baseline characteristics were consistent across groups and between patients with (dupilumab q2w: 49%/qw: 46%, placebo: 45%) or without comorbid asthma. At Week 16, more patients with comorbid asthma receiving dupilumab 300mg q2w/qw achieved IGA 0/1 (34.1%/31.9% vs 9.3%), EASI-75 (50.0%/47.4% vs 13.7%), and peak pruritus NRS improvement ≥4 (37.9%/37.8% vs 9.3%) versus placebo (p<0.0001 for all). Patients without comorbid asthma showed similar results. Treatment groups (dupilumab q2w/qw, placebo) had similar rates of adverse events (69%/67%, 69%). Injection-site reactions and conjunctivitis were more frequent in dupilumab-treated patients.
This subgroup analysis shows that dupilumab-treated patients with and without comorbid asthma have comparable/significant improvement in AD signs and symptoms. Future studies in AD patients with symptomatic comorbid asthma will help assess the potential benefit of dupilumab in both conditions.