Reduced exacerbation frequency and prednisone dose in patients with ABPA and asthma treated with dupilumab

Veer, T. van der; Dallinga, Marloes A.; Valk, J. P. M. van der; Kappen, Jasper H; Veen, J.C.C.M. in ’t; Eerden, Menno M. van der; Braunstahl, Gert‐Jan

doi:10.1002/clt2.12081

Cited by 11 publications

(4 citation statements)

References 8 publications

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“…Here, omalizumab has demonstrated good efficacy, improving exacerbation rates, glucocorticoid dosing, FEV 1 and symptoms [101][102][103][104], although optimal dosing is unknown given the highly elevated IgE levels seen in ABPA. Similar effectiveness for anti-IL-5/5R therapy has been demonstrated in both ABPA and SAFS in a growing body of case series [105,106], while evidence of a role for the IL-4α receptor antagonist dupilumab is also growing [107,108].…”

Section: Bronchiectasismentioning

confidence: 62%

Management of comorbidities in difficult and severe asthma

Khan,

Moran,

McCarthy

et al. 2023

Breathe

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Difficult-to-treat and severe asthma are challenging clinical entities. In the face of suboptimal asthma control, the temptation for clinicians is to reflexively escalate asthma-directed therapy, including increasing exposure to corticosteroids and commencement of costly but potent biologic therapies. However, asthma control is objectively and subjectively assessed based on measurable parameters (such as exacerbations or variability in pulmonary physiology), symptoms and patient histories. Crucially, these features can be confounded by common untreated comorbidities, affecting clinicians’ assessment of asthma treatment efficacy.

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Section: Bronchiectasismentioning

confidence: 62%

Management of comorbidities in difficult and severe asthma

Khan,

Moran,

McCarthy

et al. 2023

Breathe

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“…29 In some cases, however, switching from an anti-IL-5 antibody, mepolizumab, to an anti-IL-4 receptor antibody, dupilumab, reduces serum IgE levels and recruitment of eosinophils into the airways and further improves clinical presentation. 30,31 We speculate that clinical characteristics in the patients with ABPA and their treatment responses to biologics are different according to the strength of allergic and eosinophilic components in each patient.…”

Section: Discussionmentioning

confidence: 99%

Allergic bronchopulmonary aspergillosis with atopic, nonatopic, and sans asthma—Factor analysis

Okada

Yamamoto

Oguma

et al. 2023

Allergy

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BackgroundAllergic bronchopulmonary aspergillosis (ABPA) develops in the presence or absence of asthma, either atopic or nonatopic. We have tried to explore the essential components in the pathogenesis of the disease, which are either consistent and variable according to the presence and type of asthma.MethodsNon‐cystic fibrosis ABPA cases satisfying Asano's criteria were extracted from a prospective registry of ABPA and related diseases in Japan between 2013 and 2023. According to the type of preceding asthma, ABPA was classified into three groups: ABPA sans asthma (no preceding asthma), ABPA with atopic asthma, and ABPA with nonatopic asthma. Exploratory and confirmatory factor analyses were performed to identify the components that determined the clinical characteristics of ABPA.ResultsAmong 106 cases of ABPA, 25 patients (24%) had ABPA sans asthma, whereas 57 (54%) and 24 (23%) had ABPA with atopic and nonatopic asthma, respectively. Factor analysis identified three components: allergic, eosinophilic, and fungal. Patients with atopic asthma showed the highest scores for the allergic component (p < .001), defined by total and allergen‐specific IgE titers and lung opacities, and the lowest scores for the fungal component defined by the presence of specific precipitin/IgG or positive culture for A. fumigatus. Eosinophilic components, including peripheral blood eosinophil counts and presence of mucus plugs/high attenuation mucus in the bronchi, were consistent among the three groups.ConclusionThe eosinophilic component of ABPA is considered as the cardinal feature of ABPA regardless of the presence of preceding asthma or atopic predisposition.

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“…Recently, dupilumab has been shown to improve the mucus score and lung ventilation of patients with bronchial asthma with mucus plugs [11]. Treatment of ABPA with dupilumab, particularly in cases previously managed with steroids, has been reported to reduce the frequency of exacerbations and may allow for the reduction or discontinuation of steroid therapy [12,13]. Moreover, there have been previous reports of dupilumab response in patients with ABPA who are refractory to other biological agents [3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Mucus Plug Due to Allergic Bronchopulmonary Aspergillosis Using Dupilumab

Sumi,

Suzuki,

Koshino

et al. 2024

Cureus

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Allergic bronchopulmonary aspergillosis (ABPA) often necessitates treatment with systemic steroids and antifungals, which are associated with relapses and side effects. We report an 82-year-old woman with eosinophilic asthma, experiencing sputum production and dyspnea, who was diagnosed with ABPA based on her chest CT, pulmonary function tests, and elevated blood eosinophils and immunoglobulin E. Due to the presence of osteoporosis and diabetes, standard steroid therapy was considered a high risk. Instead, we administered dupilumab, an interleukin 4 receptor alpha (IL4-Rα) antibody targeting Th2 cytokine signaling. Remarkable improvements were observed within two weeks, including reduced sputum and dyspnea. After 12 weeks, significant enhancements in asthma control and lung function, along with decreased fractional exhaled nitric oxide (FeNO) levels were noted, with chest CT showing resolution of most of the mucus plugs. This case demonstrates dupilumab's potential as a viable ABPA treatment alternative, particularly for patients who are unsuitable for systemic steroids. More research on the long-term effectiveness and safety of such biologics is needed.

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Reduced exacerbation frequency and prednisone dose in patients with ABPA and asthma treated with dupilumab

Cited by 11 publications

References 8 publications

Management of comorbidities in difficult and severe asthma

Management of comorbidities in difficult and severe asthma

Allergic bronchopulmonary aspergillosis with atopic, nonatopic, and sans asthma—Factor analysis

Successful Treatment of Mucus Plug Due to Allergic Bronchopulmonary Aspergillosis Using Dupilumab

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