Super-response to dupilumab therapy in a patient with severe asthma and ABPA – a case report

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a severe hypersensitivity reaction to aspergillus species colonizing the airways of patients with asthma or cystic fibrosis. Biologicals including anti-IgE and anti-IL-5 antibiodies have strongly changed the treatment of severe asthmatics and have partly been shown to be effective in the treatment of ABPA. Recently, dupilumab, an anti-IL4-Rα antibody has been approved for the treatment of severe asthma. Here, we report the case of a 49-year old women with a history of asthma and ABPA, who suffered from severe uncontrolled asthma with an asthma control test (ACT) of 5 of 25 points despite maximum inhalative therapy, anti-IL5-Rα therapy and continued oral steroid therapy. Two exacerbations were recorded during the last 12 months. Trials of itraconazole and omalizumab showed insufficient efficacy. Lung function showed moderate obstruction with an FEV1 of 2,46l (74%), FVC of 3,43l (89,4%) and elevated FeNO of 56 ppb. Initiation of dupilumab therapy led to a complete resolution of pulmonary symptoms, resolution of exacerbations and complete withdrawal of oral steroids. ACT score increased to 25 of 25 reachable points. Serum levels of total IgE decreased from 7000 IU/ml to 4397 IU/ml, whereas eosinophils increased from