Dupilumab: A Review in Moderate to Severe Asthma

AbstractDupilumab (Dupixent®) is a fully human monoclonal antibody against the interleukin (IL)-4 receptor α subunit of IL-4 and IL-4/IL-13 receptor complexes. IL-4 and IL-13 are key cytokines in driving type 2 inflammation, a dominant and largely eosinophilic inflammatory pathway in asthma. Trials evaluating the efficacy of dupilumab in asthma include three pivotal, placebo-controlled, phase 3 or 2b tr ials of 24–52 weeks’ treatment duration in patients aged ≥ 12 years with moderate-to-severe asthma (inadequately controlled with medium-to-high dose inhaled corticosteroids) or severe asthma [dependent on oral corticosteroids (OCS) for control]. In these studies, adding subcutaneous dupilumab (200 or 300 mg every 2 weeks) to background therapy was generally well tolerated and reduced the rate of severe asthma exacerbations, improved lung function, as well as asthma control and, where specified, health-related quality of life (HR-QOL), and enabled OCS maintenance doses to be reduced with out impacting asthma control. Dupilumab displayed efficacy across various patient subgroups, although those with heightened type 2 immune activity, including elevated eosinophils and fractional exhaled nitric oxide, tended to have a more prominent treatment benefit. Dupilumab is consequently widely indicated (and a valuable treatment option) as an add-on therapy in patients aged ≥ 12 years who have severe/moderate-to-severe asthma with a type 2 inflammati...
Source: Drugs - Category: Drugs & Pharmacology Source Type: research

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Authors: Zhao Z, Chang MY, Frerichs I, Zhang JH, Chang HT, Gow CH, Möller K Abstract BACKGROUND: Since bronchial abnormalities often exhibit spatial non-uniformity which may be not correctly assessed by conventional global lung function measures, regional information may help to characterize the disease progress. We hypothesized that regional air trapping during mechanical ventilation could be characterized by regional end-expiratory flow (EEF) derived from electrical impedance tomography (EIT). METHODS: Twenty-five patients suffering from chronic obstructive pulmonary disease (COPD grade 3 or 4) or severe...
Source: Minerva Anestesiologica - Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research
Nocardiosis is an uncommon infection caused by ubiquitous environmental aerobic gram-positive filamentous bacteria, present in soil and water. Skin and lungs are usually the main targets of localized infections. Rarely, disseminated forms can occur in immunocompromised individuals. A 63-year-old man with a history of late-onset asthma and nasal and sinus polyposis treated with oral low-dose corticosteroid regimen presented with fever, headache, myalgia, skin erythematous plaques, and pustules. Brain MRI revealed multiple abscesses and pachymeningitis. 18F-FDG PET/CT was performed to assess the extent of the infection. Cuta...
Source: Clinical Nuclear Medicine - Category: Nuclear Medicine Tags: Interesting Images Source Type: research
Mycobacterium chelonae is a rare acid fast bacilli that grows rapidly when compared to other members of the Mycobacteria genus. Localized cutaneous infections (i.e. cellulitis/ abscess) are common in immunocompetent patients, but in an immune compromised host disseminated infections are more prevalent. Disseminated cutaneous manifestations most commonly present in patients who are immunosuppressed by malignancy, corticosteroid therapy, various immunomodulating drugs used in organ transplantation or secondary immunodeficiencies1.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Letters Source Type: research
Publication date: Available online 2 December 2019Source: Journal of the Formosan Medical AssociationAuthor(s): Chun-Min Kang, En-Ting Wu, Ching-Chia Wang, Frank Lu, Bor-Luen Chiang, Ting-An YenObjectiveTreatment of severe asthma exacerbation could be challenging, especially in the initial hours of acute attack when systemic corticosteroid is yet to take effect. In spite of using inhaled agents, the role of non-invasive ventilation (NIV), including Bilevel Positive Airway Pressure (BiPAP), had been addressed recently.MethodsWe reviewed 5-year experience in our hospital for records of patients who were admitted to pediatric...
Source: Journal of the Formosan Medical Association - Category: General Medicine Source Type: research
Asthma is a major cause of morbidity in children, despite the availability of various treatments. In adults, tiotropium —a long-acting muscarinic antagonist (LAMA)—as add-on therapy to an inhaled corticosteroid (ICS) with or without a long-acting β2-agonist provides clinical benefit with a safety profile similar to placebo. Objective: To review published evidence on the efficacy and safety of tiotropium as add-o n LAMA therapy in children and adolescents with asthma that is uncontrolled despite use of an ICS with or without additional controller medication(s).
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Source Type: research
CONCLUSION: Once-daily tiotropium as add-on therapy is efficacious and safe in adolescents and children with moderate-to-severe asthma. These results support the expanded indication by regulatory authorities for add-on tiotropium in patients aged ≥6 years. PMID: 31805357 [PubMed - as supplied by publisher]
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Ann Allergy Asthma Immunol Source Type: research
Abstract OBJECTIVE: Treatment of severe asthma exacerbation could be challenging, especially in the initial hours of acute attack when systemic corticosteroid is yet to take effect. In spite of using inhaled agents, the role of non-invasive ventilation (NIV), including Bilevel Positive Airway Pressure (BiPAP), had been addressed recently. METHODS: We reviewed 5-year experience in our hospital for records of patients who were admitted to pediatric intensive care unit because of severe asthma attack. The included admission records from 2012 to 2017 were grouped according to BiPAP use (Yes/No). Clinical paramete...
Source: J Formos Med Assoc - Category: General Medicine Authors: Tags: J Formos Med Assoc Source Type: research
ConclusionCRS in patients with EGPA is often refractory to medical and surgical management. Treatment of these patients should occur in a multidisciplinary setting.
Source: International Forum of Allergy and Rhinology - Category: Allergy & Immunology Authors: Tags: ORIGINAL ARTICLE Source Type: research
Publication date: Available online 30 November 2019Source: Pulmonary Pharmacology &TherapeuticsAuthor(s): Aloke Ghoshal, Pradyut Waghray, George Dsouza, Mahip Saluja, Mayank Agarwal, Ashish Goyal, Sneha Limaye, Akash Balki, Sudhir Bhatnagar, Manish Jain, Sharad Tikkiwal, Abhijit Vaidya, Meena Lopez, Rashmi Hegde, Jaideep GogtayAbstractThe combination of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABAs) is widely used for the management of asthma. This prospective, open-label, non-comparative, observational, 24-week multicentre study is the first real-world study from India to compare the efficacy and...
Source: Pulmonary Pharmacology and Therapeutics - Category: Respiratory Medicine Source Type: research
Purpose of review This review aims to recognize the multifactorial cause of asthma, from the influence of mother until adulthood, highlight the main characteristics of the disease at different ages and summarize the evidence of potential prevention strategies. Recent findings To date, regarding the prenatal period, the presence of specific genes, maternal asthma, drugs, and tobacco exposure are the most relevant predisposing features for an asthmatic offspring. For newborns, preterm, bronchopulmonary dysplasia, and low birth weight has been associated with low lung function. Among young children, atopic dermatitis, lo...
Source: Current Opinion in Pulmonary Medicine - Category: Respiratory Medicine Tags: ASTHMA: Edited by Nicola A. Hanania, Zuzana Diamant, and Maarten van den Berge Source Type: research
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