Dupilumab in severe asthma–copd overlap. Real-life experience on a case series

Background/Objective: Little is known about the efficacy of biologics and in particular Dupilumab in patients with severe asthma associated with COPD (SA-COPD) features. The objective of this study was to determine whether Dupilumab has similar clinical/functional efficacy in individuals with SA-COPD and in those with pure severe asthma (SA). Methods: We retrospectively selected 11 consecutive patients with SA with COPD features (smoking history of at least 15 pack/years; emphysema on chest CT scan; FEV1 < 80%; RV and TLC > 130%; DLCO < 70; salbutamol reversibility test < 12%) treated with Dupilumab for at least 1 year. These subjects were compared with 33 consecutive patients with SA alone who were also treated with the same biologic for at least 12 months. Results: FEV1 and FEF25–75 changes after treatment were 10 ± 18.3% and 18.6 ± 26.5% in the SA group, whereas they were 4.8 ± 7.6% and 7.2 ± 6.8% in individuals with SA-COPD (p = 0.909 and p = 0.102 respectively). Similarly, ACT (5.3 ± 3.1 vs. 5.6 ± 3.7; p = 0.783) and exacerbation changes (−2.97 ± 1.3 vs. −4 ± 4.3; p = 0.960) after Dupilumab were similar in the two groups. No differences were also found in FeNO and BEC changes (−18 ± 22 vs. −21.3 ± 21.1 ppb and −63.6 ± 415 vs. −142 ± 299 cells/µL respectively; p = 0.984 and p = 0.481). The percentages of subjects that reduced and stopped OC therapy and those that stepped down the level of ICS dose after treatment were also similar in the two populations. After adjustment for multiple confounding factors, changes in all evaluated outcomes also remained comparable between patients with SA-COPD and those with SA. Conclusions: In our experience, Dupilumab is effective both in patients with SA alone and in those with asthma–COPD overlap. We must always consider T2 inflammation in the management of such patients in order to provide the most appropriate treatment.