Dupilumab Reduces Asthma Exacerbations and Improves Control in Children Regardless of Asthma Duration

Regardless of asthma duration, dupilumab (Dupixent; Sanofi, Regeneron) reduced exacerbations and improved asthma control when compared with placebo, according to research published in the Journal of Allergy and Clinical Immunology and presented at the 2026 American Academy of Allergy, Asthma & Immunology Annual Meeting. Additionally, lung function normalization and clinical remission rates appeared greater in those with shorter durations of disease.¹

Dupilumab is a human monoclonal antibody administered subcutaneously to inhibit the interleukin-4 receptor subunit α. It has FDA-approved indications for moderate-to-severe, resistant, atopic dermatitis unresponsive to conventional therapy, including topical corticosteroids; as a maintenance treatment for asthma and chronic rhinosinusitis with nasal polyposis in adults and children, alongside with other medications; prurigo nodularis; and eosinophilic esophagitis. Non–FDA-approved indications include allergic contact dermatitis, hand dermatitis, chronic spontaneous urticaria, and alopecia areata. Additionally, research also suggests its efficacy in treating conditions characterized by Th2-mediated inflammation.²

These findings are from a post hoc analysis of the VOYAGE (NCT02948959)³ clinical trial, a randomized, double-blind, placebo-controlled, parallel group phase 3 trial to evaluate the efficacy and safety of dupilumab in children aged 6 to less than 12 years of age with uncontrolled moderate to severe persistent asthma. Patients were randomly assigned to receive either dupilumab (100 mg for those weighing ≤30 kg, and 200 mg for those weighing >30 kg) or matched placebo once every 2 weeks while receiving a stable dose of standard background therapy.^1,3

Trial end points were analyzed by asthma duration subgroup: week 52 patient proportions achieving no exacerbations, well-controlled asthma (7-item Asthma Control Questionnaire ≤0.75), normalized prebronchodilator forced expiratory volume in 1 second (FEV₁) z-score (> -1.64), and clinical remission.^1,3

A total of 350 children were enrolled for this analysis. The findings indicated that dupilumab reduced annualized exacerbation rates across all subgroups: 68% for those with asthma 4 years or less; 47% for those with asthma over 4 years and less than 7; and 71% for those with asthma at least 7 years. Additionally, all of these respective patient subgroups were less likely to have no severe asthma exacerbations than those receiving placebo (86.7% vs 72.1%, P = .044; 71.3% vs 54.8%, P = .036; and 74.3% vs 48.3%, P = .005).¹

Further, there were higher proportions of dupilumab-treated children who achieved well-controlled asthma (78.7% vs 55.8%, P = .011; 67.8% vs 42.9%, P = .010; and 62.2% vs 34.5%, P = .019) and normalized FEV₁ z-scores (78.7% vs 72.1%, P =.485; 72.4% vs 61.9%, P = .426; and 67.6% vs 65.5%, P = .921) than those treated with placebo. Clinical remission was also achieved by more patients receiving dupilumab (OR: 2.55 [95% CI 1.09–5.96], P =.030; 2.04 [95% CI 0.85–4.90], P = .110; and 3.87 [95% CI 1.12–13.43], P = .033).¹

When counseling parents and pediatric patients, pharmacists should explain that the medication works by calming the type of inflammation that drives asthma, which can reduce flare-ups and improve day-to-day symptom control. They should clarify that dupilumab is a maintenance medication and does not replace a rescue inhaler for sudden symptoms. Pharmacists can also demonstrate proper subcutaneous injection technique, review appropriate injection sites and rotation, discuss preparation before administration, and reinforce the importance of adherence.

Given the findings suggesting improved outcomes in patients with shorter disease duration, pharmacists can emphasize the importance of consistent therapy and early optimization when appropriate. Additionally, because biologic therapies can be costly, pharmacists play an important role in assisting with prior authorizations, coordinating specialty pharmacy services, and identifying manufacturer assistance programs to help ensure access and continuity of care.

REFERENCES

1. Phipatanakul W, Guilbert T, Gappa M, et al. Children With Asthma Receiving Dupilumab Had Reduced Exacerbations and Improved Asthma Control Versus Placebo, Regardless Of Asthma Duration. J Allergy Clin Immunol. 2026;157(2, Supplement):AB40. doi:10.1016/j.jaci.2025.12.124

2. Gade A, Ghani H, Patel P, Rubenstein R. Dupilumab. StatPearls [Internet]. Updated February 28, 2024. Accessed March 2, 2026. https://www.ncbi.nlm.nih.gov/books/NBK585114/

3. Evaluation of Dupilumab in Children With Uncontrolled Asthma (VOYAGE). ClinicalTrials.gov identifier: NCT02948959. Updated March 28, 2022. Accessed March 2, 2026. https://clinicaltrials.gov/study/NCT02948959