Dupilumab efficacy in relation to changes in club cell secretory protein 16.

BACKGROUND

Although the performance of dupilumab in severe asthma has been evaluated, the detailed mechanism underlying its effect remains unclear.

OBJECTIVE

To analyze the effect of dupilumab on serum club cell secretory protein 16 (CC16).

METHODS

A total of 25 patients who were administered dupilumab and underwent computed tomography before and approximately 4 months after the introduction of dupilumab were included. Clinical and computed tomography parameters before and after dupilumab administration, such as mucus plug score and wall area measurement, were compared along with serum CC16 levels. The correlation between the clinical background and treatment effects was also evaluated.

RESULTS

The number of mucus plugs and airway wall area decreased significantly after dupilumab introduction. The number of mucus plugs was positively correlated with both age and serum IgE levels. The number of mucus plugs and airway wall area was inversely correlated with percent of predicted forced expiratory volume in 1 second (FEV1) and maximal mid-expiratory flow. Dupilumab treatment resulted in a significant increase in serum CC16 levels and led to a significant improvement in asthma symptoms, quality-of-life scores, FEV1, and exacerbation frequency. In addition, changes in CC16 were significantly correlated with changes in the fraction of exhaled nitric oxide, IgE, quality-of-life score, FEV1, maximal mid-expiratory flow, and mucus plug score.

CONCLUSION

These data suggest that dupilumab improves symptoms and respiratory functions by altering the airway epithelial environment.