A new study confirms the effectiveness of Dupilumab in treating asthma, especially severe asthma. This new treatment received its marketing authorization in the United States in 2017.
An essay published in The New England Journal of Medicine indicates that dupilumab has a beneficial effect in the treatment of severe asthma. It remains to be seen how to define “severe asthma”, in order to correctly target the patients to whom the new treatment is prescribed. Dupilumab, which blocks both interleukin-4 and interleukin-13, received marketing authorization in the United States in 2017.
The researchers randomly assigned 1,902 patients aged 12 or older with uncontrolled asthma. They received either a dose of 200 or 300 mg every 2 weeks or a placebo. The experiment lasted 52 weeks. As a result, patients who received dupilumab had “significantly lower rates of severe asthma exacerbation” than those who received placebo, as well as better lung function and more assertive asthma control. Greater benefits have been seen in patients with higher levels of eosinophils (a type of white blood cell, the cells that are involved in immune defense against infection).
Divide the number of asthma attacks by two
Nonetheless, eosinophilia, which is a continuous rise in one type of white blood cell in the blood, was observed in some members of the cohort. Last March, a new study had also shown that dupilumab, originally used to fight eczema, could cut the number of asthma attacks in half. More than 2000 patients participated in the research. All had moderate to severe asthma and were given 200-300 milligrams of dupilumab every 15 days for a year.
Severe asthma is a clinical entity characterized by a patient who is uncontrolled in terms of his symptoms despite treatment described as optimal and specialized follow-up of at least six months. Epidemiological data agree between 5 and 10% of asthma cases as severe asthma. In France, around 4 million people suffer from asthma: there are nearly 60,000 hospitalizations (nearly 40,000 in children) and around 1,000 deaths each year. The first attacks usually occur in the first year of life in 10 to 50% of cases, before the fifth year in 65 to 95% of cases, or after 10 years, but this is rare.
Hypersensitivity to different stimuli
Asthma is a chronic disease caused by inflammation of the bronchi which results in their hypersensitivity to different stimuli: cold, virus, tobacco, pollution … Bronchial inflammation causes “hyperreactivity” of the muscle wall with swelling of the wall internal bronchus, hypersecretion of mucus (normally produced in small amounts) and contraction of the muscles of the bronchial wall. In the end, all these phenomena result in the narrowing of the lumen of the bronchus, even in its obstruction, and in a gene to breathe.
Inflammation and hyperreactivity of the bronchial wall appear to be favored by risk factors: some are “endogenous”, ie specific to the patient, and others are “exogenous”, ie. say external to the patient (allergens, pollution, viruses, etc.). Among the “endogenous” risk factors, we find a family allergic ground and especially personal in nearly 9 patients out of 10. These genetic factors predispose to asthma, but also to become allergic to substances which are breathed in daily, such as “mites”, indoor dust, animal hair or pollen. This predisposition is called “atopy”.
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