Allergy immunotherapy in combination with biological therapy in moderate and severe asthma

Abstract

Background. Allergen immunotherapy (AIT) is a pathogenetic substantiated method for the allergic disease’s treatment, which allows reducing the symptom severity and decreasing the medication use. Uncontrolled severe asthma is a contraindication for AIT. The appointment of biological therapy helps to improve the asthma control, but their cancellation is impossible. The combined use of the biological therapy and AIT makes it possible to achieve the long-term symptoms control in patients with severe asthma, increase the AIT safety, and probably stop biological therapy. Aim. To evaluate the efficacy and safety of combination therapy with dupilumab and AIT in patients with severe asthma. Materials and methods. The study involved 30 adult patients with moderate to atopic severe asthma. Patients was randomized for 3 groups: group 1: standard therapy (0–52 weeks) + dupilumab (0–16 weeks) + AIT (12–16 weeks); group 2: standard therapy without biological therapy (0–52 weeks) + AIT (12–16 weeks); group 3: standard therapy without biological therapy, without AIT (0–52 weeks). We evaluated the asthma control and comorbidities using questionnaires (ACQ, AQLQ, TNSS, SNOT-22, DQLQ), respiratory function (FEV1), the number of exacerbations and adverse events At control points (initially, after 12, 20 and 52 weeks). Results. As a result of the appointment of dupilumab it was possible to quickly achieve asthma control and comorbidities (12 wk), which made it possible to successfully conduct AIT. In the first group, symptom control is maintained even after discontinuation of both dupilumab and AIT. ACQ-6 52 wk: 1 group – 0.30±0.21; 2 group – 1.62±0.51; 3 group – 2.76±0.85. FEV1 52 wk: group 1 – 81.47±7.48%; group 2 – 73.99±6.17%; group 3 – 65.02±7.23% for 3 group (р<0.01). In the first group, there weren’t adverse events that allowed complete AIT successfully, unlike for the second group, where, maximum tolerated allergen dose was lower due to development of systemic reactions. Conclusion. Combined treatment with dupilumab and AIT allows to quickly achieve a control, decrease a background therapy and adverse events during the AIT. The control of asthma symptoms and the effect of AIT were maintained even after the end of dupilumab therapy.

Keywords

• asthma
• atopic asthma
• severe asthma
• targeted therapy
• monoclonal antibodies
• biologicals
• dupilumab
• allergy immunotherapy