Eczema drug effective against severe asthma

Eczema drug, dupilumab reduces severe asthma symptoms and improves patients' ability to breathe better than standard therapies, according to two studies published in NEJM.

Patients receiving dupilumab, regardless of dose, improved their lung function by approximately 130-200 milliliters greater than those receiving the placebo. Dupilumab is an injectable anti-inflammatory drug approved in 2017 by the Food and Drug Administration as a treatment for eczema, a chronic skin disease.

Although the eczema drug significantly reduced asthma symptoms for all patients, dupilumab worked particularly well in patients with high numbers of eosinophils, circulating in the bloodstream. In such patients, asthma exacerbations were cut by two-thirds

More than 2,000 patients were enrolled in the studies who suffered from moderate to severe asthma and used standard asthma inhalers, and some also took oral steroids to control their exacerbations.

In one study, the rate of asthma exacerbations was reduced to half for those taking dupilumab compared with those taking a placebo. On average, patients taking a placebo had close to one exacerbation per day during the year of the study.

The first study included about 1,900 patients of at least 12 years of age and with moderate to severe asthma and used at least three different inhalers to control their symptoms. One inhaler contained a corticosteroid that reduces inflammation, another contained a long-acting bronchodilator that relaxes airway muscles, and the third was a "rescue" inhaler filled with albuterol, a short-acting bronchodilator that quickly opens up the airway in the event of a more severe asthma attack.

Patients taking these inhaled medications were randomly assigned to receive either dupilumab or a placebo for one year. Patients receiving dupilumab -- an injectable antibody -- also were randomly assigned to a higher or lower dose of the drug.

In addition to reduced symptoms, the patients receiving dupilumab showed improved lung function in a test of "forced expiratory volume." This test measures the amount of air a person can force from the lungs during a deep exhale. Patients receiving dupilumab, regardless of dose, improved their lung function by approximately 130-200 milliliters greater than those receiving the placebo. In general, there were no significant differences between the patients receiving high and low doses of dupilumab

Rates of emergency room (ER) visits and hospitalizations also were improved for patients receiving the drug. In the placebo group (with 638 patients), on average, 6.5 percent of the patients required an emergency room visit or hospitalization due to asthma during the study. In the dupilumab group (with 1,264 patients), on average, 3.5 percent of patients needed emergency care or hospitalization due to asthma.

The second study included about 200 patients using the same inhaled asthma medications as patients in the larger trial, plus additional oral steroids, usually prednisone, to control their more severe symptoms.

Half of the patients receiving dupilumab in this study were able to completely eliminate prednisone use. And 80 percent of dupilumab-treated patients were able to at least cut their doses in half.

A certain dupilumab side effect was seen in the patients receiving dupilumab like including pain and swelling at the injection site and a short-term bump in the number of eosinophil cells in the blood.