TITLE:
Five-Year Experience with Dupilumab in Children and Adolescents with Severe Asthma: A 16-Case Series
AUTHORS:
Ricardo Donado-Botero, Camila Durán-Naizir, Cesia Avilez-Cogollo, Andrea Castillo-Pérez, Valentina Coderque-Sepúlveda, Yunis Arevalo-Barrios, María José Carmona-Marrugo, Carolina González-García, Stefany Sampayo-Anaya, Andrés Ahumada-Uribe, Sebastián Gamarra-Hernadéz, Duván Contreras-Arrazola
KEYWORDS:
Dupilumab, Severe Pediatric Asthma, Type 2 Inflammation, Ambispective Multicenter Case Series, Colombia, Longitudinal Outcomes
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.13 No.11,
October
30,
2025
ABSTRACT: Background: Severe pediatric asthma remains burdensome despite optimized inhaled therapy, and chronic oral corticosteroids (OCS) carry substantial harm during growth. Dupilumab targets IL-4Rα to inhibit IL-4/IL-13 signaling central to type-2 inflammation. Objective: To describe five-year clinical, functional, and biological outcomes in a real-world pediatric cohort with severe type 2 asthma treated with add-on dupilumab. Methods: Ambispective, longitudinal case series of children/adolescents (6 - 17 years) initiating dupilumab between 2020-2025. Annual assessments included asthma control (ACT/c-ACT, ACQ-5), severe exacerbations (systemic corticosteroids ≥3 days, emergency care, or hospitalization), spirometry (FEV1, FVC, FEV1/FVC; GLI-2012), biomarkers (FeNO, blood eosinophils, total IgE), OCS use/dose, and safety. Analyses were primarily descriptive (medians [IQR], frequencies). Results: Sixteen patients were included (median age 12 years; 56% male; allergic/mixed T2 phenotypes common). At baseline, median ACT/c-ACT was 14, severe exacerbations 3/year, FEV1 72% predicted, FeNO 38 ppb, and 38% required daily OCS (10 mg prednisone-equivalent). After dupilumab initiation, control improved steadily (ACT/c-ACT 23 by 2025; ACQ-5 0.7), severe exacerbations fell to 1 in year 1 and 0 from 2023 onward, and FEV1 rose to 92% predicted by 2025, with reduced bronchodilator reversibility. FeNO declined to 13 ppb, with downward trends in eosinophils and IgE. All patients discontinued maintenance OCS by year 3. Safety was favorable (mild injection-site reactions, transient eosinophilia, occasional conjunctivitis; no treatment-limiting events). Conclusions: In real-world pediatric practice, dupilumab was associated with sustained improvements in asthma control, exacerbation suppression, physiological recovery of lung function, biomarker modulation, and complete OCS withdrawal over five years, with a reassuring safety profile. These data complement pediatric trial evidence and support earlier, sustained biologic therapy in appropriately selected children.