Treatment of Allergic Bronchopulmonary Aspergillosis with Dupilumab Reduces IgE Levels and is Well Tolerated in Three Children with Cystic Fibrosis

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a common complication in cystic fibrosis (CF), leading to decreased lung function and frequent pulmonary exacerbations. Standard treatments, including glucocorticoids and antifungal medications, have limited long-term benefits and are often not well tolerated. Methods: This case series explores the use of dupilumab, a monoclonal antibody targeting the IL-4/IL-13 pathways, as treatment for ABPA in three pediatric patients with CF. Results: The results showed significant improvements in biomarkers such as total IgE and Aspergillus-specific antibodies as well as a reduction in the need for corticosteroids and antifungal agents. However, the clinical outcomes varied, with some patients experiencing limited improvement in lung function and continued challenges with pulmonary exacerbations and coexisting infections. Conclusions: The mechanism of dupilumab offers a novel therapeutic approach to managing ABPA inflammation. Further studies are needed to better understand the efficacy and safety in the treatment of ABPA in children with CF.