Echocardiographic effects of dupilumab in patients with severe type 2 asthma

Background: Severe asthma is characterized by impaired lung function and elevated cardiovascular risk. Type 2 inflammation, primarily mediated by IL-4 and IL-13, contributes to both airway and cardiac remodeling. Dupilumab, an IL-4Rα antagonist, has shown efficacy in improving respiratory outcomes; however, its impact on cardiac function remains insufficiently studied. Objective: To assess the 12-month effects of dupilumab on echocardiographic parameters and evaluate its potential association with clinical remission in patients with severe type 2 asthma. Methods: This single-centre observational study enrolled 24 patients with severe type 2 asthma receiving dupilumab. Echocardiographic assessments and lung function tests were conducted at baseline and after 12 months. Clinical remission was defined by meeting all of the following: zero exacerbations, zero OCS use, ACT score ≥20, and pre-bronchodilator FEV1 ≥ 80 % predicted. Results: Twelve-month dupilumab therapy led to significant improvements in both cardiac and respiratory parameters. LV-GLS improved from −17.00 % to −19.00 % and RV-GLS from −17.33 % to −19.11 % (both p < 0.0001). TAPSE and TAPSE/S-PAP ratio also increased significantly (p < 0.0001). Lung function showed notable gains in FEV1 and FEF25-75, alongside reductions in residual volume and airway resistance. Clinical remission was achieved by 45.83 % of patients. Baseline LV-GLS emerged as a strong predictor of remission (AUC = 0.832), unlike RV-GLS (AUC = 0.545). Conclusions: Dupilumab markedly improved cardiac and pulmonary function and may promote clinical remission. Baseline LV-GLS may serve as a predictive marker, supporting cardiovascular assessment in asthma management.