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Researchers from McMaster University and the Firestone Institute for Respiratory Health at St. Joseph’s Healthcare Hamilton, with colleagues at other partnering institutions, have developed a new method to treat severe asthma. In a study of over 200 participants with severe asthma, the new treatment improved asthma symptoms and lung function, while reducing the need for corticosteroids by up to 70%.
Current treatments for severe asthma include high doses of corticosteroids, such as prednisone, to control exacerbations. Reducing the need for corticosteroids with alternative treatments is preferable, since these medications are associated with serious side effects from prolonged use- including multi-organ toxicities and immunosuppression.
Dr. Parameswaran Nair, staff respirologist at St. Joseph’s Healthcare Hamilton and professor of medicine at McMaster University, along with a team of researchers found that an antibody called dupilumab is effective in treating severe asthma in place of high doses of prednisone.
Researchers sought participants who had been using oral corticosteroids (prednisone) to treat severe asthma for at least six months prior to the study. In addition to their standard regimen of corticosteroids, patients received either dupilumab or a placebo during the 24 week trial. The corticosteroid dose was gradually reduced during weeks four to 20, and maintained at a low level for the final four weeks.
The ability of dupilumab to increase lung function as markedly as it did in this study, even in the face of [corticosteroid] withdrawal, indicates that it appears to be inhibiting key drivers of lung inflammation. Dupilumab treats asthma by blocking two specific proteins- interleukin-4 and interleukin-13 that are associated with inflammation of the airways.
Blocking interleukin-5 allowed patients with high eosinophil levels in their blood and airways to reduce their corticosteriod dose. Eosinophils are a type of white blood cell involved with the production of interleukins. High eosinophil levels are directly linked to an increased risk of severe asthma.
Dupilumab is effective regardless of patients’ eosinophil levels. Despite the reduced prednisone dose, patients in the study experienced a decrease in asthma exacerbations andinproved lung function also improved significantly.
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