D3.153 - Add-on Dupilumab therapy significantly reduces severe asthma exacerbations and emergency visits in patients with severe persistent asthma requiring oral corticosteroids for maintenance therapy: our experience in Réunion Island

Few therapeutic options, including the use of regular oral corticosteroids (OCS), remain for patients with inadequately controlled severe persistent asthma.

Dupilumab, a fully humanized monoclonal antibody that blocks interleukin IL-4 and IL-13 signal, has previously demonstrated efficacy in atopic dermatitis, allergic rhinitis, and asthma. However, there is no study showing the efficacy dupilumab therapy in patients with severe asthma in a French overseas tropical region.

Objective: Our study assessed the efficacy add-on dupilumab therapy in patients with severe persistent asthma requiring OCS.

We enrolled 20 patients (aged ≥ 18 years) with persistent severe asthma (95% met GINA 2025 criteria, step 5) and with baseline blood eosinophiles ≥ 150 cells/ mL.

10 patients were assigned to receive subcutaneous dupilumab 300mg every 2 weeks and 10 patients not receiving dupilumab (control group). Efficacy was evaluated by calculating the annualized rates of asthma exacerbations, severe exacerbations, and emergency visits.

Add-on dupilumab therapy significantly reduced the rates of severe exacerbations by 71% in the dupilumab group, as compared with 32% in the control group (P<0.001). Total emergency visit rates were significantly reduced during dupilumab therapy by 82% (P=0.014). Rates of severe exacerbations, total emergency visits, emergency room visits, and unscheduled doctor’s visits were more than halved with dupilumab in our patients.

Our study demonstrated that add-on dupilumab consistently reduced the rates of asthma exacerbations, severe exacerbation, and emergency visits in patients with persistent severe asthma who require regular OCS.

Dupilumab should be considered as add-on therapy in those difficult-to-treat patients who continue to suffer with inadequately controlled severe persistent asthma despite receiving all the available asthma medications.