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When one plus one means more than two: the blockade of both IL-4 and IL-13 inflammatory pathways with dupilumab in a case of severe refractory T2-high asthma
  1. Carmelo Sofia1,
  2. Jacopo Simonetti1,
  3. Cristina Boccabella1 and
  4. Matteo Bonini1,2
  1. 1Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy
  2. 2National Heart and Lung Institute (NHLI), Imperial College London, London, UK
  1. Correspondence to Dr Carmelo Sofia; carmelosofia93{at}gmail.com

Abstract

Novel approach of asthma includes personalised therapy involving specific immune pathways. We describe here a case of T2-high asthma in a 66-year-old woman treated with maximal inhaled therapy and inappropriate usage of oral corticosteroids showing poor symptoms control. Both anti-IgE and (omalizumab) and anti-interleukin (IL)-5 (mepolizumab) monoclonal antibodies treatments were prescribed without significant benefit. Add-on subcutaneous dupilumab, a monoclonal antibody directed against the IL-4 receptor subunit alpha, inhibiting signalling from both IL-4 and IL-13, proved to be an effective and safe medication to obtain rapid asthma control. Considering the previous lack of response to both anti-IgE and anti-eosinophilic strategies, we hypothesise that dupilumab upstream activity could exert different and more relevant effects than the simple inhibition of the two single downstream pathways. The current case highlights the need for a deeper analysis of biomolecular interactions in the framework of different asthma endotypes, to identify peculiar profiles associated with specific treatment responses.

  • asthma
  • drugs: respiratory system
  • lung function

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Footnotes

  • Contributors MB and CB has supervised this study. CS and JS has written the report. CS and JS has contributed equally to this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.