DUPILUMAB significantly improved lung function in patients with asthma and allergic bronchopulmonary aspergillosis (ABPA), according to findings from a phase 2 trial. The treatment was associated with fewer severe respiratory exacerbations and reduced systemic corticosteroid use compared with placebo, while overall safety was consistent with its known safety profile.
ABPA is an allergic hypersensitivity reaction to Aspergillus species that can complicate and worsen asthma. The condition is associated with an intense type 2 immune response in the lower airways, while no targeted therapies are currently approved specifically for ABPA. The study investigated dupilumab, a fully human monoclonal antibody that blocks interleukins 4 and 13 through their shared interleukin 4 receptor alpha.
The double-blind phase 2 trial enrolled patients with asthma aged 12 years and older who met clinical criteria for ABPA. Participants were randomised to receive dupilumab (n=35) or placebo (n=27) for 24–52 weeks. Chronic systemic corticosteroids were being used by 37.1% of participants at baseline.
The primary endpoint was the change from baseline in prebronchodilator forced expiratory volume in 1 second (FEV1) at week 24. Additional outcomes included severe respiratory exacerbations and systemic corticosteroid use.
At week 24, prebronchodilator FEV1 improved significantly more with dupilumab than placebo: least squares mean change was 0.203 L versus 0.002 L, respectively. The least squares mean treatment difference was 0.201 L (95% confidence interval: 0.08–0.33; p=0.002).
The adjusted annualised severe respiratory exacerbation rate was 0.695 per person-year with dupilumab compared with 1.551 with placebo, representing a 55.2% reduction. However, the nominal p value was 0.0627.
Among patients requiring systemic corticosteroids at baseline, 71.4% of those receiving dupilumab no longer required corticosteroids at week 24, compared with 14.3% receiving placebo.
Overall safety was consistent with the known dupilumab safety profile, and the treatment was described as well tolerated.
The findings support further consideration of dupilumab as a potential targeted treatment approach for patients with asthma and ABPA. However, the study was a phase 2 trial with a relatively small randomised population, and the reported results provide evidence of efficacy at 24 weeks rather than definitive evidence regarding longer-term outcomes. Further investigation would be needed to establish the role of dupilumab in the longer-term management of ABPA.
Reference
Bourdin A et al. Dupilumab efficacy and safety in patients with allergic bronchopulmonary aspergillosis. JACI.2026;DOI:10.1016/j.jaci.2026.08.021.
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