When asthma is not controlled even on high dose inhalational corticosteroids with other controller with or without oral corticosteroids,it is called severe therapy resistant asthma(STRA).

If the child is diagnosed with type 2 airway inflammaton, biologics are the choice in these scenario.

There are so many biologics in the market but few are approved for children.

According to a study on 408 children with the mean age of 8.9 years ,Dupilumab was found to be consistently effective and safe.

Dupilumab was used as an injection by subcutaneous route.

It was given in the dose of 100mg,twice in a week for children equal to or less than 30  kg of weight.

For children more than 30 kg of weight ,the dose was 200 mg biweekly.

According to the study protocol,the dose was increased to 300 biweekly in children equal to or less than 30 kg of weight in mid study period.

The treatment was given for a period of 52 weeks.

At the end of the study period, common adverse effects were nasopharyngitis in 9%,pharyngitis in 6%, upper respiratory infection in 8% and eosinophilia in 3 %,

Serious adverse effects were seen only in 7 children

This study concluded that ,Dupilumab  decreased the level of type 2 inflammatory biomarkers like level of serum IgE and blood eosinophils significantly.

It also concluded that ,this is the only biologic agent which reduced the number of asthma exacerbations as well as consistently and significantly improved lung function as measured by spirometry in the form of significant improvement in FEV1.

REFERENCES:

Bacharier LB, Maspero JF, Katelaris CH, et al. Assessment of long-term safety and efficacy of dupilumab in children with asthma (LIBERTY ASTHMA EXCURSION): an open extension study,Lancet Respir Med. Published online November 10, 2023. doi:10.1016/S2213-2600(23)00303-X