TY - JOUR T1 - Journal club JF - Thorax JO - Thorax SP - 424 LP - 424 DO - 10.1136/thoraxjnl-2022-218881 VL - 77 IS - 4 AU - Amy G Nuttall Y1 - 2022/04/01 UR - http://thorax.bmj.com/content/77/4/424.abstract N2 - Dupilumab, a monoclonal antibody that blocks interleukin 4 (IL-4) and interleukin 13 (IL-13), the principal mediators of inflammation in children with asthma, is now approved for treatment of asthma in adults and adolescents. As part of the Liberty Asthma VOYAGE trial, Bacharier et al assessed the efficacy and safety of dupilumab administered every 2 weeks (<30 kg=100 mg subcutaneously (SC), >30 kg=200 mg SC) in children aged 6–11 years with moderate-to-severe asthma (N Engl J Med 2021; DOI:10.1056/NEJMoa2106567). They randomised 408 children with moderate-to-severe asthma (dupilumab, n=273; placebo, n=135) and split into two primary efficacy populations: type 2 inflammatory asthma (blood eosinophils ≥150 cells/mm3 or FENO ≥20 ppb) and patients with blood eosinophils ≥300 cells/mm3. All patients receiving dupilumab had significantly lower rates of severe exacerbations (relative risk 0.46, 95% CI 0.31 to 0.67) than the placebo group, were more likely to remain exacerbation free and had fewer courses of systemic glucocorticoids. The dupilumab group also had greater improvement in predicted prebronchodilator FEV1 (least-squares mean difference 4.7, 95% CI 1.9 to 7.5) and greater improvement in Asthma Control Questionnaire (ACQ-7) scores (least-squares mean difference −0.28, 95% CI −0.44 to −0.12). In the population studied, dupilumab … ER -