M21 The effect of dupilumab on asthma exacerbation frequency including patients on maintenance oral steroids

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Introduction and Objectives NICE recommends dupilumab in severe type 2 inflammation driven asthma with eosinophils ≥150cells/µL, FeNO ≥25ppb and ≥4 exacerbations annually.1 Although high-cost therapies in Wales are not regulated through the Blueteq system, the South Wales MDT aims to follow its guidance. This excludes patients taking maintenance oral steroids from dupilumab treatment. However, as dupilumab’s Blueteq content was unconfirmed when it became available in Wales, some patients taking oral steroids were treated, with a primary aim of exacerbation reduction. Clinical trials of dupilumab in glucocorticoid-dependent asthma used a higher dose than that approved by NICE.2 Methods Retrospective 12-month analysis from an initial patient cohort commenced on 200mg dupilumab fortnightly. Results 34 patients were identified. Five were excluded: 2 stopped treatment early due to side effects, one moved out of area and 2 did not attend annual review. Of the 29 remaining patients, 15 (52%) were taking maintenance prednisone. Table 1 details changes in exacerbation frequency and steroid dosing following 12 months of treatment. Of the 15 patients on baseline steroids, 6 (40%) experienced a ≥50% reduction in both exacerbation frequency and steroid dose. A further 2 (13%) experienced a ≥50% reduction in exacerbation frequency alone, 4 (27%) ≥50% reduction in steroid dose alone and 3 (20%) experienced neither. Conclusions A 200mg dose of dupilumab fortnightly enabled meaningful steroid reduction in addition to exacerbation prevention this small cohort of patients. References NICE TA751 Dupilumab for treating severe asthma with type 2 inflammation, 2021. Rabe KF, et al. N Engl J Med. 2018;383:35–48.

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