Medical Doctor San Tan Allergy Arizona Allergy and Immunology Research Gilbert, Arizona, United States
Background: Asthma prevalence in adolescents has increased in recent years yet remains under-studied. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin (IL)-4 and IL-13, key and central drivers of type 2 inflammation in multiple diseases. In the phase 3 QUEST study (NCT02414854), add-on dupilumab 200mg/300mg every 2 weeks vs matched placebo reduced annualized rates of severe exacerbations, improved lung function and quality of life, and was generally well tolerated in patients aged ≥12 years with uncontrolled, moderate-to-severe asthma. Similar efficacy was observed between adults and adolescents and in subgroups of patients with evidence of allergic asthma or type 2 comorbidities such as allergic rhinitis (AR) and chronic rhinosinusitis with nasal polyps. This post hoc analysis compared the proportions of adolescent and adult patients enrolled in QUEST who met allergic criteria or had type 2 inflammatory comorbid disease.
Objective:
Design/Methods: Adolescent (aged ≥12–17 years) and adult (aged ≥18 years) patients were eligible for enrollment. The proportions of adolescents and adults meeting the most commonly used allergic criteria in US clinical practice (≥1 perennial aeroallergen-specific IgE ≥0.35 IU/mL and total IgE ≥30 IU/mL) or with history of type 2 inflammatory comorbid disease (atopic dermatitis, allergic conjunctivitis, AR, chronic rhinosinusitis, nasal polyposis, eosinophilic esophagitis, food allergy, hives) were assessed.
Results: Among adolescent patients, 81% in the combined dupilumab 200mg/300mg groups and 87% in the combined placebo groups met allergic criteria, compared with 56% and 55% of adult patients (Table). Similarly, proportions of patients with history of type 2 inflammatory comorbidities were higher in adolescent subgroups (dupilumab: 93%; placebo: 97%) compared with adult groups (dupilumab: 78%; placebo: 79%). The most frequently observed perennial aeroallergen-specific IgE ≥0.35 IU/mL were seen in higher proportions of adolescent patients than in adult patients, including Aspergillus fumigatus, Alternaria tenuis/alternata, and cat dander. Conclusion(s): In the QUEST study, dupilumab improved asthma symptoms and lung function in patients with uncontrolled asthma. Although the study enrolled a comparably small number of adolescents (n=107), a higher proportion met allergic criteria or had history of type 2 inflammatory comorbidities compared with adults.
Authors/Institutions: Neal Jain, Arizona Allergy and Immunology Research, Gilbert, Arizona, United States; Jacqueline Eghrari-Sabet, FAAR Institute, Gaithersburg, Maryland, United States; Nadia Daizadeh, Sanofi, Cambridge, Massachusetts, United States; Benjamin Ortiz, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, United States; Nami Pandit-Abid, Sanofi, Bridgewater, New Jersey, United States; Yamo Deniz, Regeneron Pharmaceuticals, Inc., Tarrytown, New York, United States; Paul Rowe, Sanofi, Bridgewater, New Jersey, United States
