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Biologic Treatment Considerations for Asthma During the COVID-19 Pandemic and the Upcoming Flu Season - Episode 10

Dupilumab for Moderate to Severe Asthma


Stanley Goldstein, MD: You mentioned dupilumab. Let’s hear some more information regarding dupilumab, because that may be in its own class by itself and how . How do you decide?. Let’s talk about the mechanism of action of dupilumab and also, again, where you would place it in the algorithm.

Giselle Mosnaim, MD, MS: Dupilumab blocks the IL-4 receptor alpha, and it is important for the IL-4 and IL-13 pathways in asthma. Dupilumab is a self-injection at home every two 2 weeks. It’s also approved for atopic dermatitis. So, in this situation, if I have a patient with asthma and comorbidities of atopic dermatitis, dupilumab has a nice fit there. In terms of the safety profile with Ddupilumab, it has a very good safety profile. I do caution patients about potential eye symptoms, but that has not seemed to be too much of an issue. Again, we have the patients get the first injection in our office with nurse teaching, and then after that they continue treatment at home.

Stanley Goldstein, MD: Do you have any other thoughts about as far as the mechanism of action and when you would use an anti-IL-5 or dupilumab? I know you’ve mentioned the comorbid conditions, obviously chronic rhinosinusitis and nasal polyps. Giselle, yYou also mentioned, Giselle, about the differentiation with that, is it’s home therapy. It’s always been home therapy. I should say, Aas opposed to the other ones which were initially administered in the office, but now mepolizumab and benralizumab also have home therapies as well. Any other way of deciding when to when am I going to use a dupilumab? Bbesides we discussed the comorbid conditions.? We know if you look at the data as far as the patients as, the demographics of the patients in the phase 3 dupilumab studies included patients with atopic disease. They have the approval to specific indication, dupilumab is approved for those patients who have the eosinophilic phenotype, but we know that in the clinical studies, you had those patients who, yes, had the eosinophilic phenotype, they also had patients with an atopic phenotype, and they speak about also the mixed phenotype. So howHow do you fit that into the whole decision-making of when you’re going to use it? , Bbesides obviously shared decision with what’s easier for that patient. ? How about just the physiologic mechanism? Thoughts about that?

Giselle Mosnaim, MD, MS: I think this is the big, big question right now. I think that inIn this field, I think we’re all discussing and trying to figure out which biologic to start with, how long to stay on a particular biologic before you assess efficacy, do you switch to another biologic and under what circumstances do you switch?. These are the big questions that we’re having asking right now. I tend to choose biologics very much in terms of what the patient, when I explain the different dosing plans, that’s a huge thing for the patient. When I look at the comorbidities, that’s also something very big that I look at. I tend to keep the patient on the medication for at least three 3 months before assessing maximal efficacy. So I let the patients know “We need to stay on this for three 3 months to really see how well it’s working for you.” I have seen dramatic improvements, patients that have been on daily oral steroids, patients that have had huge impact on their quality of life, and then we go on to a biologic and after three 3 months they’re off of their oral steroids, they’re blood pressure is better, their blood sugars are better, their quality of life is tremendously improved.

Transcript Edited for Clarity