Use of dupilumab on the treatment of moderate-to-severe asthma: a systematic review

Bassani, Cíntia; Rossi, Larissa; Siveris, Kaian; Sferelli, Rafaella Lorenzon; Saraiva, Leonardo; Tanno, Luciana Kase

doi:10.1590/1806-9282.65.9.1223

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Revista da Associação Médica Brasileira

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REVIEW ARTICLE • Rev. Assoc. Med. Bras. 65 (9) • Sept 2019 • https://doi.org/10.1590/1806-9282.65.9.1223 copy

Use of dupilumab on the treatment of moderate-to-severe asthma: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE

The objective of this article was to conduct a systematic review of the treatment of moderate-to-severe asthma by administrating Dupilumab.

METHODS

A search on the online databases EBSCO, Scielo, PubMed, Medline Bireme, Lilacs, and The New England Journal of Medicine was conducted, publications from 2010 to 2018 were selected. The inclusion criteria were articles which contained control groups, tested the validity of Dupilumab, and verified the response of patients through controlled tests. For the search of such articles, the following keywords were used: “Dupilumab”, “asthma”, “Bronchial Asthma” AND “Asthma, Bronchial” AND their correspondent in Portuguese “asma”, “Asma brônquica” and “Asma brônquica”. The exclusion criteria were literature reviews, news, articles without control groups, articles on different subjects, Dupilumab studies on other diseases, articles concerning asthma without the use of Dupilumab, and repeated articles on the databases were discarded.

RESULTS

The literature considers that the medication shows a good response for the treatment of moderate-to-severe asthma and assists in the improvement of lung function, aside from resulting in few side effects. It presents good efficacy, safety, and tolerance by patients.

CONCLUSIONS

Dupilumab is promising for the treatment of asthma, whereas conventional therapy is deemed to be insufficient. More additional studies are needed to confirm the long-term safety and effectiveness.

Dupilumab; Asthma; Bronchial diseases; Anti-Asthmatic Agents

Database	First Criterion	Second Criterion
	Total Included	Total Included
EBSCO	20 0	0 0
SCIELO	0 0	0 0
MEDLINE	64 1	1 1
LILACS	1 1	1 0
PUBMED	67 1	1 1
NEW ENGLAND J	13 3	3 3
Total	165 6	6 5

Reference	Date of publication	Number of individuals and age group	Medication dosage	Outcome
Busse et al.¹	May, 2018	1902 patients aged ≥12 years were randomized in a 2: 2: 2: 1 ratio. three groups. Duration of 52 weeks	Group 1: 634 patients. 300 mg of Dupilumab every two weeks. Group 2: 364 patients, 200 mg of Dupilumab every two weeks. Group 3: 317 patients, placebo.	Dupilumab had an excellent response to moderate to severe uncontrolled asthma, provides improvement in respiratory function and control of asthma. Severe exercise reduction and improved quality of life
Castro et al.²	June, 2018	1902 patients aged ≥12 years with uncontrolled asthma divided in 2: 2: 1 ratio. Three groups. Duration of 52 weeks.	Group 1: 300 mg of Dupimulab every two weeks. Group 2: 200 mg of Dupimulab every two weeks. Group 3: Placebo.	Patients who received Dupimulab had a significant improvement in lung function, asthma control, and minor exacerbations of severe asthma compared to the placebo group.
Rabe et al.³	June, 2018	210 patients aged ≥ 12 years. Two groups. Duration of 24 weeks.	Group 1: 200 mg of Dupimulab every two weeks. Group 2: Placebo.	The use of Dupimulab decreases the exacerbation of severe asthma and improved FEV1.
Wenzel et al.⁴	April, 2016	769 patients aged≥ 18 years, of whom 611 were in the Dupimulab and 158 in the placebo group. Five groups with a ratio of 1: 1: 1: 1: 1. Duration of 24 + 16 weeks.	Group 1: 200 mg of Dupimulab every 4 weeks. Group 2: Dupimulab 300 mg every 4 weeks. Group 3: 200 mg of Dupimulab every 2 weeks. Group 4: 300 mg of Dupimulab every 2 weeks. Group 5: Placebo.	Groups using Dupilumab, except for 200 mg every 4 weeks, showed a significant improvement in FEV1, reduced asthma exacerbation and eosenophilia. The best results were found in the 300 mg Dupilumab group every 2 weeks.
Wenzel et al.⁵	June, 2013	104 patients, divided into two, each with 52 patients. One group received Dupilumab and the other placebo. Duration of 12 weeks.	Group 1: 300 mg Dupilumab weekly. Group 2: Placebo.	The use of Dupilumab reduced asthma exacerbations and levels of inflammatory markers associated with Th2, in addition to showing improvement in lung function.

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[1] CORRESPONDING AUTHOR: Leonardo Saraiva BR 285 – Passo Fundo – Rio Grande do Sul – Brasil – 99052-900 – Tel:+55 54 33168384 E-mail: leo77saraiva@hotmail.com