Reduced exacerbation frequency and prednisone dose in patients with ABPA and asthma treated with dupilumab
Abstract
To the Editor, Allergic bronchopulmonary aspergillosis (ABPA) is a difficult‐to‐treat disease caused by airway inflammation triggered by an excessive allergic response to inhaled fungal spores. ABPA typically occurs in patients with asthma or cystic fibrosis and is characterized by dyspnea, cough, mucus plugs, and frequent exacerbations and is associated with bronchiectasis. High total serum IgE levels and high eosinophil counts are key biomarkers of ABPA. To date, the cornerstone of ABPA treatment is systemic steroids. Azole antifungals are often used as an adjunctive treatment for nonresponders or as a steroid‐sparing agent. As steroids and azole antifungals often carry harmful side effects, it is of great importance to find alternative therapies. Here, we present a series of eight patients with a diagnosis of allergic ABPA and asthma who were treated with dupilumab, a novel biological therapeutic agent. Dupilumab is an interleukin (IL)‐4 alpha receptor antagonist impeding IL‐4 and IL‐13 signaling, broadly inhibiting type 2 inflammation by counteracting IgE producing B‐cells and eosinophils. This gives dupilumab a rational mechanism of action in ABPA. Dupilumab efficacy in patients with ABPA and asthma has previously been reported in single case reports. A post hoc analysis of the LIBERTY trial also showed reduced exacerbations in 18 participants treated with dupilumab who had serologic markers suggestive of ABPA but no formal diagnosis. Our retrospective case series…
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