Eosinophilia and Adverse Effects of Dupilumab for Respiratory Indications: A Real-World Setting

Sylvia H. Li, Katharine Foster Nehme, Anna Moshkovich, Lydia Suh, Anna Pawlowski, Yasmeen Ali, Gayatri B. Patel, Fei Li Kuang, Anju T. Peters*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Dupilumab has been used with significant benefit in the treatment of asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Phase 3 clinical trials have demonstrated transient eosinophilia and rare eosinophil-related and other adverse effects. Objective: To characterize dupilumab-associated eosinophilia (absolute eosinophil count ≥1.5 × 103/μL within 36 weeks of dupilumab initiation) and adverse effects associated in real-world patients with asthma and CRSwNP in the United States. Methods: Retrospective chart review of 251 patients receiving dupilumab for asthma and/or CRSwNP seen at a single institution. Results: Among the 142 patients who had absolute eosinophil counts checked before and after treatment, 16 (11.3%) had posttreatment eosinophilia, including 11 (7.7%) who had new eosinophilia on dupilumab initiation. Thirteen patients with posttreatment eosinophilia remained on dupilumab, 10 of whom had resolution of eosinophilia. Eosinophil-related adverse effects were rare, and cases of eosinophilic granulomatous polyangiitis were limited to one patient with eosinophilia and one patient with normal eosinophil levels who was receiving systemic corticosteroids. Other adverse effects included arthralgias (13 of 251; 5.2%), rash (8 of 251; 3.2%), and conjunctivitis (7 of 251; 2.8%). All patients with pretreatment eosinophilia and most patients with posttreatment eosinophilia received significant treatment benefit for the respiratory disease with dupilumab. Conclusions: Whereas dupilumab-associated eosinophilia is seen in a subset of patients, persistent eosinophilia or eosinophil-related adverse effects are rare. Furthermore, treatment benefit with dupilumab despite eosinophilia supports its continued use in both asthma and CRSwNP.

Original languageEnglish (US)
Pages (from-to)121-131
Number of pages11
JournalJournal of Allergy and Clinical Immunology: In Practice
Volume13
Issue number1
DOIs
StatePublished - Jan 2025

Funding

Supported by the Chronic Rhinosinusitis Integrated Studies Program 2 (Grant P01AI145818 ) and the Division of Allergy and Immunology, Ernest Bazley Foundation . Conflicts of interest: G.B. Patel received research support from Sanofi Regeneron; F.L. Kuang received a research grant from AstraZeneca. A.T. Peters received research support from Astra Zeneca and Sanofi Regeneron and was a consultant for AstraZeneca, Sanofi Regeneron, GSK, and Eli Lilly. The rest of the authors declare that they have no relevant conflicts of interest.

Keywords

  • Adverse effects
  • Asthma
  • Chronic rhinosinusitis
  • Dupilumab
  • Eosinophilia
  • Eosinophilic granulomatosis with polyangiitis
  • Nasal polyps

ASJC Scopus subject areas

  • Immunology and Allergy

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