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Dupilumab for AERD — RACP Adult Medicine MCQ

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ModerateRespiratoryDupilumab for AERDRACP Adult Medicine

A 42-year-old woman presents with recurrent episodes of wheeze and dyspnoea triggered by aspirin. She has nasal polyps and severe asthma. Her blood eosinophils are 800 cells/µL. She has failed standard high-dose ICS/LABA, LTRA, and nasal corticosteroids. What biologic targeting aspirin-exacerbated respiratory disease specifically improves nasal polyposis AND asthma?

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Correct answer: B — Dupilumab (anti-IL4Rα)

Dupilumab (anti-IL-4 receptor alpha – blocks both IL-4 and IL-13) is uniquely positioned for AERD/Samter's triad because it is the only biologic with TGA/PBS approval for BOTH severe eosinophilic asthma AND chronic rhinosinusitis with nasal polyposis (CRSwNP). The LIBERTY ASTHMA and SINUS trials demonstrated significant benefit for both conditions. Anti-IL-5 agents (mepolizumab, benralizumab) are effective for eosinophilic asthma and have emerging data for CRSwNP. However, dupilumab is the only agent with dual approval addressing both the upper and lower airway disease that characterises AERD.

Reference: eTG – 2025 – Respiratory; GINA – 2024; PBS – 2025 – Dupilumab Listings