Monica Kraft, MD: Dupilumab's Two-Fold Targeting


What makes the monoclonal antibody so enticing to the asthma community?

It’s still more than a week before the US Food and Drug Administration (FDA) is required to rule on the supplemental biologics application (sBLA) of dupilumab (Dupixent) as an add-on therapy for adult and adolescent patients with asthma. But early discussion at the 2018 CHEST Annual Meeting in San Antonio, TX, has been forward-thinking—to a time when the monoclonal antibody is already granted the indication.

Sanofi and Regeneron Pharmaceuticals bolstered the therapy’s case this week at CHEST, releasing supplemental data from the LIBERTY ASTHMA program, showing dupilumab’s benefits in treating exacerbations and improving lung function in adolescent patients with uncontrolled asthma.

Already approved for improperly controlled atopic dermatitis, the biologic therapy has clinical involvement across a swarth of inflammatory conditions. Monica Kraft, MD, Department of Medicine Chair at the University of Arizona College of Medicine — Tuscon, sat down with MD Magazine® at CHEST to discuss the characteristics of dupilumab which make it such a benefit for asthma care.

MD Mag: What is dupilumab's mechanism of action in fighting inflammation?

Kraft: Dupilumab is an exciting biologic for us in the asthma world, because it targets 2 different kinds of cytokines: interleukin 4 and 13. Because they share a common receptor, the alpha 4 receptor 4, and so by targeting that receptor, you get both.

Why does that matter? IL-4 is really important in the allergic response, in IgE (immunoglobulin E) formulation, and that side of things. IL-13 has a lot of effects on the airway, in terms of collagen deposition. It affects smooth muscle, increases contraction of smooth muscle, increases production of mucus—all the things that are abnormal in the asthmatic airway.

So, to think we could get both of those—and actually, data has shown benefits in patients who have allergy and patients who have eosinophils or not. It targets a very large population of potential patients with severe asthma. So that's exciting.

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