S95 Effect of dupilumab treatment on mucus plugging and mucus volume in type 2 asthma: the phase 4 VESTIGE trial

• DOI: 10.1136/thorax-2024-btsabstracts.101
• Publication Date: 2024-11-04T09:40:58Z
• Authors: C Porsbjerg; EM Dunican; NL Lugogo; M Castro; A Papi; V Backer; CE Brightling; A Bourdin; JC Virchow; M Zhang; X Soler; PJ Rowe; Y Deniz; L de Prado Gómez; H Sacks; JA Jacob-Nara
• Keywords: Dupilumab

<h3>Introduction</h3> Mucus hypersecretion resulting from type 2 cytokines (e.g., interleukin [IL]-13) drives intermittent airway obstruction and remodeling. Dupilumab blocks the shared receptor component for IL-4/IL-13, improved lung function, reduces rates of severe exacerbations in patients (≥12 years) with moderate-to-severe asthma up to 3 years, or years children (6–11 years). The VESTIGE study (NCT04400318) assessed dupilumab's impact on mucus plugging, volume, inflammation, related function changes asthma. <h3>Methods</h3> Patients (aged 21–70 uncontrolled asthma, elevated biomarkers (baseline blood eosinophils ≥300 cells/µL fractional exhaled nitric oxide [FeNO] ≥25 ppb), pre-bronchodilator percent predicted forced expiratory volume 1 second (pre-BD ppFEV₁) ≤80%, ≥1 exacerbation year prior, were randomized 2:1 add-on dupilumab 300 mg (n=72) matched placebo (n=37) every weeks (q2w) 24 weeks. A validated scoring system was used quantify number bronchopulmonary segments completely occluded mucus, a plug score [0–20]. Quantification voxels per plug, measured by computed tomography, determined volume. We also proportion achieving FeNO &lt;25 ppb least squares (LS) mean change pre-BD FEV₁ at Week 24. <h3>Results</h3> At 24, treated had reduced scores (LS difference [standard error, SE] baseline −4.9 [0.8] points vs placebo; nominal <i>P</i>&lt;0.001) volumes (−0.107 [0.020] mL <i>P</i>&lt;0.001). receiving 9.8 times more likely achieve than those (<i>P</i>&lt;0.001). In addition, an improvement observed [SE] placebo: 0.38 [0.11] L; Furthermore, improvements strongly associated decreases dupilumab-treated (Pearson's correlation coefficient −0.618; <i>P</i>&lt;0.0001) (table 1). <h3>Conclusion</h3> treatment led significant reduction plugging as well contributing function.