TOPLINE

Dupilumab improved lung function, showed trends toward better asthma control, reduced levels of type 2 inflammation markers and corticosteroid dependence in patients with asthma and allergic bronchopulmonary aspergillosis (ABPA) compared with placebo, with a safety profile consistent with previous studies.

METHODOLOGY

• Researchers conducted a phase 2 trial between 2020 and 2024 to evaluate the efficacy and safety of dupilumab in patients with asthma and ABPA.
• The trial enrolled 62 patients (median age, 59.0 years; 62.9% women) who were randomly assigned to receive 300 mg dupilumab or placebo subcutaneously every 2 weeks for 24-52 weeks, with posttreatment follow-up for an additional 12 weeks.
• The primary outcome was an improvement in lung function, assessed as a change in prebronchodilator forced expiratory volume in 1 second (FEV₁) at week 24.
• Secondary outcomes included asthma control, evaluated using the Asthma Control Questionnaire-5 (ACQ-5); quality of life, assessed using the St. George's Respiratory Questionnaire (SGRQ); and type 2 inflammation marker levels, including total and Aspergillus fumigatus-specific immunoglobulin (Ig)E levels.

TAKEAWAY

• At week 24, the change in prebronchodilator FEV₁ was significantly greater among patients who received dupilumab than among those who received placebo (least squares mean difference, 0.201 L; P = .002); no drug-related serious adverse events (SAEs) were reported.
• At week 52, the mean SGRQ score decreased by 25.3 points with dupilumab vs 8.9 points with placebo. Similar results were observed for ACQ-5 scores, which decreased by 1.3 points with dupilumab vs 0.8 points with placebo.
• With dupilumab, the median percent reduction in total IgE levels at week 52 was 64.5% and that in A fumigatus-specific IgE levels was 62.0%, whereas with placebo, no median change in either measure was observed.
• Overall, 71.4% of the patients in the dupilumab group vs 14.3% in the placebo group stopped using systemic corticosteroids by week 24; mean mucus plug scores decreased from 2.35 to 1.19 in the dupilumab group, whereas scores increased from 3.00 to 3.35 in the placebo group.

IN PRACTICE

"This analysis provides the first evidence from a randomized placebo-controlled trial that dupilumab improves outcomes in patients with asthma and ABPA," the authors wrote.

SOURCE

Arnaud Bourdin, MD, with the University of Montpellier, Montpellier, France, was the corresponding author of this study, which was published online on September 4, 2026, in the Journal of Allergy and Clinical Immunology.

LIMITATIONS

The study required a protocol amendment to reduce the sample size due to recruitment challenges during the COVID pandemic, which limited the overall statistical power. Secondary and exploratory endpoints were assessed using descriptive statistics only, limiting the strength of conclusions. Patients with ABPA associated with cystic fibrosis or chronic obstructive pulmonary disease were excluded, and results may not apply to these populations.

DISCLOSURES

The study was funded by Sanofi and Regeneron Pharmaceuticals Inc. Several authors reported being employees and shareholders of the companies that funded the study. Multiple authors reported receiving grants, consulting fees, personal fees, or speaker fees from several pharmaceutical companies; one author reported serving on an advisory board.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.