Dupilumab is a monoclonal antibody used in severe asthma. A previous real-life study by our group has shown rapid clinical improvements after the first dose of dupilumab (Renner et al. Immun Inflamm Dis. 2021 Sep).?Patients with smoking history are excluded from RCTs and currently no data exist that show effectiveness in these patients.

The aim of this real-life study was to investigate if the effectiveness of dupilumab in ex-smokers (>10 packyears) is comparable to the effectiveness in never-smokers and ex-smokers with less than 10 packyears at four weeks after initiation of dupilumab treatment. 

We retrospectively analysed asthma control and FEV1 in all patients who had received dupilumab at the severe asthma centre of Clinic Hietzing, Vienna.

50 patients have so far received dupilumab at Clinic Hietzing, 20 of which (40%) were ex-smokers. In the overall population improvements in median ACQ6 (-1.17 points) and median ACT (+7 points) were clinically and statistically (both p<0.001) significant after 4 weeks. Mean FEV₁ improved by 160 mL (p<0.001). In ex-smokers asthma control (median ACQ6 -1,5 points, p<0.001; median ACT +8 points, p<0.001) and lung function (mean FEV₁ +178 mL, p=0.004) improvements were comparable to the overall population. Two-way mixed-method ANOVA did not show a significant main effect of smoking status on changes in ACQ6 (p=0.432), ACT (p=0.463) and FEV₁ (p=0.305) after 4 weeks of treatment.

This is the first study that shows rapid, real-life effectiveness of dupilumab irrespective of smoking status. Further analysis is needed to compare long-term effectiveness between these groups but these data support the use of dupilumab in severe asthma patients who are ex-smokers.