RECENT findings from the VOYAGE and EXCURSION studies confirm the efficacy of dupilumab, a monoclonal antibody targeting IL-4 and IL-13, in children aged 6–11 years with moderate-to-severe type 2 asthma.
The VOYAGE trial was a 52-week, placebo-controlled study where children received dupilumab (100/200 mg biweekly, based on body weight) as add-on therapy. In the subsequent 52-week EXCURSION extension study, all participants were switched to dupilumab. Key endpoints included the annualised rate of severe exacerbations and changes in pre-bronchodilator percent predicted forced expiratory volume in one second (ppFEV1). The studies examined the effects of dupilumab in patients with and without evidence of allergic asthma, characterised by total serum IgE ≥30 IU/mL and ≥1 perennial aeroallergen-specific IgE ≥0.35 kU/L.
In VOYAGE, dupilumab significantly reduced annualised severe exacerbations by 57.0% in children with allergic asthma and by 49.1% in those without. These reductions were sustained in EXCURSION over the additional year of treatment.
At the end of VOYAGE, dupilumab significantly improved pre-bronchodilator ppFEV1 in children with allergic asthma, with a least squares mean difference versus placebo of 9.45 percentage points (95% CI: 5.14–13.77; P<0.0001). Improvements in children without allergic asthma were numerically positive but not statistically significant (4.60 percentage points; 95% CI: -1.99–11.20; P=0.1685).
In EXCURSION, improvements in ppFEV1 were sustained for all groups. Among those with allergic asthma, mean increases were 13.1% (SD: 19.5) in patients continuing dupilumab and 9.9% (SD: 15.9) in those transitioning from placebo. In patients without allergic asthma, increases were 11.2% (SD: 13.5) and 8.4% (SD: 17.3), respectively.
Dupilumab significantly reduces severe exacerbations and improves lung function in children with moderate-to-severe type 2 asthma, regardless of allergic status, offering sustained benefits over two years. These findings highlight its potential as a long-term treatment option for paediatric asthma.
Ada Enesco, EMJ
Reference
Papadopoulos NG et al. Long-term dupilumab assessment in children with type 2 asthma with or without evidence of allergic asthma. D010. ACAAI Annual Scientific Meeting, 24–28 October, 2024.
