Dupilumab efficacy and safety in patients with asthma and blood eosinophils >= 500 cells.mu L-1

Uncontrolled, moderate-to-severe asthma in patients with high baseline blood eosinophils (≥500 cells·µL−1) can be difficult to treat [1]. Global Initiative for Asthma guidelines recommend biologics as add-on therapy for patients with severe type 2 inflammatory asthma that remains uncontrolled despite treatment with high-dose inhaled corticosteroids [2]. Surrogate markers of type 2 inflammation such as elevated levels of blood or sputum eosinophils and fractional exhaled nitric oxide (FeNO) can be used to identify patients with a type 2 signature who might be eligible for such treatment [1–3]. Several biologics are now available that target different molecules in type 2 inflammatory pathways, notably IgE and type 2 cytokines [1–3]. One of these, dupilumab, is a fully human VelocImmune®-derived [4, 5] monoclonal antibody that blocks the shared receptor component for interleukin-4 and interleukin-13, cytokines that are key and central drivers of type 2 inflammation in multiple diseases, thus inhibiting their signalling [6, 7]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. K.F. Rabe is a consultant for and received speaker fees from AstraZeneca, Boehringer Ingelheim, Novartis, Sanofi and Teva. Conflict of interest: Dr. I.D. Pavord received speaker fees from Aerocrine AB, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Teva; received payments for organizing education events from AstraZeneca and Teva; received consulting fees from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Dey Pharma, Genentech, GlaxoSmithKline, Knopp Biosciences, Merck, MSD, Napp Pharmaceuticals, Novartis, Regeneron Pharmaceuticals, Inc., RespiVert, Sanofi, Schering-Plough and Teva; has received international scientific meeting sponsorship from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Napp Pharmaceuticals and Teva; received research grant from Chiesi; and is consultant for Regeneron Pharmaceuticals, Inc. and Sanofi. Conflict of interest: Dr. M. Castro received research support from American Lung Association, AstraZeneca, GlaxoSmithKline, NIH, Novartis, PCORI, Pulmatrix, sanofi-aventis and Shionogi; is a consultant for Genentech, Novartis, sanofi-aventis and Teva; received speaker fees from AstraZeneca, Genentech, GlaxoSmithKline, Regeneron Pharmaceuticals, Inc., Sanofi and Teva; received royalties from Elsevier. Conflict of interest: Dr. M.E. Wechsler reports personal fees from AstraZeneca, Boehringer Ingelheim, Equillium, Gala Therapeutics, Genentech, Genzyme, Mylan, Novartis, Pulmatrix, ResTORbio, Regeneron Pharmaceuticals, Inc., Sentien Biotechnologies and Teva; and grants and personal fees from GlaxoSmithKline and Sanofi. Conflict of interest: Dr. N. Daizadeh, U. Kapoor, R.R. Johnson, P.J. Rowe and J.A. Jacob-Nara are employees and may hold stock and/or stock options in Sanofi. Conflict of interest: Dr. B. Ortiz, A. Radwan and Y. Deniz are employees and shareholders of Regeneron Pharmaceuticals, Inc.