1. Blood eosinophils and fractional exhaled nitric oxide are prognostic and predictive biomarkers in childhood asthma.
- Author
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Bacharier, Leonard B., Pavord, Ian D., Maspero, Jorge F., Jackson, Daniel J., Fiocchi, Alessandro G., Mao, Xuezhou, Jacob-Nara, Juby A., Deniz, Yamo, Laws, Elizabeth, Mannent, Leda P., Amin, Nikhil, Akinlade, Bolanle, Staudinger, Heribert W., Lederer, David J., and Hardin, Megan
- Abstract
[Display omitted] Blood eosinophils and fractional exhaled nitric oxide (F eno) are prognostic biomarkers for exacerbations and predict lung function responses to dupilumab in adolescents and adults with asthma. We evaluated the relationship between baseline blood eosinophils and F eno and response to dupilumab in children with asthma. Children aged 6 to 11 years with uncontrolled moderate-to-severe asthma (n = 408) were randomized to receive dupilumab 100/200 mg by body weight or volume-matched placebo every 2 weeks for 52 weeks. Annualized exacerbation rate (AER) reduction and least squares mean change in prebronchodilator percent predicted forced expiratory volume in 1 second (ppFEV 1) at week 12 were assessed according to cutoff baseline levels for F eno (<20 ppb vs ≥20 ppb) and blood eosinophil count (<150, ≥150 to <300, ≥300 to <500, and ≥500 cells/μL). Quadrant analyses in populations defined by biomarker thresholds and spline models across continuous end points assessed the relationship with F eno and eosinophil count. Interaction testing evaluated the independent roles of F eno and blood eosinophils as predictive markers. Exacerbation risk and magnitude of AER reduction increased in subgroups with higher baseline biomarker levels. Quadrant analyses revealed that disease of patients with either elevated F eno or eosinophil counts demonstrated a clinical response to dupilumab. Interaction testing indicated blood eosinophil counts or F eno independently added value as predictive biomarkers. In children with uncontrolled moderate-to-severe asthma, blood eosinophil counts and F eno are clinically relevant biomarkers to identify those at risk for asthma exacerbations, as well as those with disease with clinical response to dupilumab. Liberty Asthma VOYAGE ClinicalTrials.gov NCT02948959. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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