key: cord-0730137-5y1fkmxp
authors: van der Veer, Tjeerd; Dallinga, Marloes A.; van der Valk, Johanna P. M.; Kappen, Jasper H.; in ’t Veen, Johannes C. C. M.; van der Eerden, Menno M.; Braunstahl, Gert‐Jan
title: Reduced exacerbation frequency and prednisone dose in patients with ABPA and asthma treated with dupilumab
date: 2021-12-03
journal: Clin Transl Allergy
DOI: 10.1002/clt2.12081
sha: fc33cfefec7b3ae146c76b6c489259440705876b
doc_id: 730137
cord_uid: 5y1fkmxp

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efficacy in patients with ABPA and asthma has previously been reported in single case reports. 3, 4 A post hoc analysis of the LIBERTY trial also showed reduced exacerbations in 18 participants treated with dupilumab who had serologic markers suggestive of ABPA but no formal diagnosis. 5 Our retrospective case series approved by the institutional review board presents eight patients with allergic asthma as well as ABPA diagnosed by a pulmonologist according to the diagnostic criteria of the International Society for Human and Animal Mycology. 1 All patients provided written informed consent for data collection.

Dupilumab prescription was indicated in these patients to treat underlying uncontrolled allergic eosinophilic asthma. The patients' number of exacerbations, maintenance prednisone dose, FEV1, total IgE levels, and eosinophil counts were compared between baseline and 6 months prior to first administration of dupilumab versus 6 months after start of dupilumab treatment. An exacerbation was defined as a worsening of symptoms for which a temporarily increased dose of steroids was prescribed.

Seven males and one female were included with a median age of 72 years. All patients had the diagnosis of ABPA for more than 1 year and were on maintenance prednisone treatment at baseline, except one patient. All patients used inhaled corticosteroids and bronchodilators. Seven patients had a history of azole antifungals treatment. Five patients had a strong reduction in total serum IgE, while followup measurements of serum IgE were not available for the other three patients. Eosinophil counts were unavailable for comparison in most patients (see Table 1 ). This is the largest reported case series of dupilumab treatment for diagnosed ABPA patients with a comparison of key outcome measures. Our findings indicate that dupilumab had strong clinical and biochemical effects. Most importantly, a significant reduction in the number of exacerbations along with a significant reduction in maintenance prednisone dose was observed in this case series. Sideeffects were limited, which is consistent with other studies which showed a favorable dupilumab safety and tolerability profile. 6 

Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria

Mechanisms of dupilumab

Dupilumab treatment for allergic bronchopulmonary aspergillosis: a case series

Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?

Dupilumab efficacy in patients with uncontrolled, moderate-to-severe allergic bronchopulmonary aspergillosis

Real-world efficacy and safety of dupilumab use in the treatment of asthma

Efficacy and safety of treatment with dupilumab for severe asthma: a systematic review of the EAACI guidelines-Recommendations on the use of biologicals in severe asthma

Gert-Jan Braunstahl https://orcid.org/0000-0001-7671-3742