Clinical and molecular response to treatment with dupilumab in patients with severe type 2 asthma

<bold>Introduction:</bold> Patients with severe asthma (SA) may present with type 2 (T2) inflammatory disease as shown by elevated exhaled nitric oxide (FeNO), total circulating IgE (cIgE) and peripheral eosinophilia. Dupilumab is a human monoclonal antibody that inhibits the signaling of both IL-4 and IL-13 and has potentially multiple sites of action that remain to be fully elucidated. <bold>Aims and objectives:</bold> To determine clinical and molecular response to dupilumab treatment in patients with severe T2 asthma. <bold>Methods:</bold> 19 adult SA patients treated at University Medical Centre Ljubljana from November 2021 to December 2023 were included in a prospective real-life study. Clinical, inflammatory and immunological parameters were measured at baseline before dupilumab introduction and after 12 months of follow-up. <bold>Results:</bold> Dupilumab treatment significantly improved FEV 1 % (p=0,0085), reduced asthma oral corticosteroids (OCS) related exacerbations (p=0,0051) and reduced levels of cIgE (p=0,0386). There was no significant difference in peripheral eosinophilia (p=0,1327) and FeNO (p=0,0555). <bold>Conclusion:</bold> Introduction of dupilumab to patients with severe T2 asthma resulted in decreased levels of cIgE, concomitant improvement of lung function parameters and fewer OCS related SA exacerbations. Further research is needed to clarify whether the reduction of specific IgE is also associated with specific atopies and clinical outcomes.