Abstract
Aim. To evaluate the efficacy and safety of combination therapy with dupilumab and AIT in patients with severe asthma.
Materials and methods. The study involved 30 adult patients with moderate to atopic severe asthma. Patients was randomized for 3 groups: group 1: standard therapy (0–52 weeks) + dupilumab (0–16 weeks) + AIT (12–16 weeks); group 2: standard therapy without biological therapy (0–52 weeks) + AIT (12–16 weeks); group 3: standard therapy without biological therapy, without AIT (0–52 weeks).
We evaluated the asthma control and comorbidities using questionnaires (ACQ, AQLQ, TNSS, SNOT-22, DQLQ), respiratory function (FEV1), the number of exacerbations and adverse events At control points (initially, after 12, 20 and 52 weeks).
Results. As a result of the appointment of dupilumab it was possible to quickly achieve asthma control and comorbidities (12 wk), which made it possible to successfully conduct AIT. In the first group, symptom control is maintained even after discontinuation of both dupilumab and AIT. ACQ-6 52 wk: 1 group – 0.30±0.21; 2 group – 1.62±0.51; 3 group – 2.76±0.85. FEV1 52 wk: group 1 – 81.47±7.48%; group 2 – 73.99±6.17%; group 3 – 65.02±7.23% for 3 group (р<0.01). In the first group, there weren’t adverse events that allowed complete AIT successfully, unlike for the second group, where, maximum tolerated allergen dose was lower due to development of systemic reactions.
Conclusion. Combined treatment with dupilumab and AIT allows to quickly achieve a control, decrease a background therapy and adverse events during the AIT. The control of asthma symptoms and the effect of AIT were maintained even after the end of dupilumab therapy.
Key words: asthma, atopic asthma, severe asthma, targeted therapy, monoclonal antibodies, biologicals, dupilumab, allergy immunotherapy.
For citation:Kulichenko D.S., Pavlova K.S., Kurbacheva O.M., Ilina N.I. Allergy immunotherapy in combination with biological therapy in moderate and severe asthma. Clinical review for general practice. 2023; 4 (8): 13–23 (In Russ.). DOI: 10.47407/kr2023.4.8.00326
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