Efficacy of soluble IL-4 receptor for the treatment of adults with asthma

Background: IL-4 mediates important proinflammatory functions in asthma, in cluding induction of the IgE isotype switch, increased expression of vascul ar cell adhesion molecule 1 and promotion of eosinophil transmigration acro ss the endothelium, stimulation of mucus production, and T(H)2 Lymphocyte d ifferentiation, leading to release of IL-4, IL-5, IL-9, and IL-13. Objective: The current study evaluated the therapeutic potential of inhaled recombinant human soluble interleukin-4 receptor (IL-4R) as an IL-4 antago nist. Methods: This study was a randomized, double-blind, placebo-controlled stud y in 62 subjects involving 12 once weekly nebulizations of 0.75, 1.5, or 3. 0 mg of IL-4R or placebo. During screening, subjects documented dependence on inhaled corticosteroids by an exacerbation in asthma induced by one or t wo 50% dose reductions at 2-week intervals. After restabilization for 2 wee ks on the dose above which their asthma flared, inhaled steroids were disco ntinued, patients were randomized, and study medication was started on day 0. Results: IL-4R was well tolerated, Efficacy was demonstrated by a decline i n FEV1 observed in the placebo group (-0.4 L and -13% predicted), which did not occur in the group receiving 3.0 mg of IL-4R (-0.1 L and -2% predicted ; P = .05 over the 3-month treatment period). Daily patient-measured mornin g FEV1 also demonstrated a significant decline in the placebo gronp (-0.5 L and -18% predicted), which did not occur in the group receiving 3.0 mg of IL-4R (-0.1 L and -4% predicted; P = .02 over the 3-month treatment period) , The efficacy of IL-4R was further confirmed by the absence of increase in asthma symptom scores in the group receiving 3.0 mg of IL-4R (Delta 0.1) c ompared with that seen in the placebo group (Delta 1.3 over 1 month; P = .0 7), Study discontinuation for asthma exacerbation was not significantly dif ferent between groups (placebo, 56%; 3.0 mg of IL-4R, 47%; P = not signific ant). Conclusion: These promising data suggest that IL-4R is safe and effective i n the treatment of moderate persistent asthma.