Methods for treating allergy and enhancing allergen-specific immunotherapy by administering an IL-4R antagonist
Methods for enhancing the efficacy, safety, and/or tolerability of a grass allergen-specific subcutaneous immunotherapy (SCIT) regimen in a subject having a grass allergy are provided. Methods comprising administering to a subject in need thereof a therapeutic composition comprising an interleukin-4 receptor (IL-4R) antagonist, such as an anti-IL-4R antibody or antigen-binding fragment thereof, are provided.
1. A method for enhancing the efficacy and/or tolerability of a grass allergen-specific subcutaneous immunotherapy (SCIT) regimen in a subject having a grass allergy, the method comprising administering to the subject one or more doses of an interleukin-4 receptor (IL-4R) antagonist in combination with the SCIT regimen, wherein at least one dose of the IL-4R antagonist is administered prior to the start of the SCIT regimen, and wherein the IL-4R antagonist is an anti-IL-4R antibody, or an antigen-binding fragment thereof, that comprises the heavy chain complementarity determining regions (HCDRs) of a heavy chain variable region (HCVR) comprising the amino acid sequence of SEQ ID NO:1 and the light chain complementarity determining regions (LCDRs) of a light chain variable region (LCVR) comprising the amino acid sequence of SEQ ID NO:2.
2. The method of claim 1 , wherein the SCIT regimen comprises subcutaneous administration of a grass extract that is from a grass selected from the group consisting of Timothy, Bahia, Bermuda, Johnson, Kentucky bluegrass, Orchard, Redtop, Rye, Sweet Vernal, Meadow Fescue, and combinations thereof.
3. The method of claim 2 , wherein the grass extract is from Timothy grass.
4. The method of claim 1 , wherein the SCIT regimen comprises a cluster SCIT regimen.
5. The method of claim 4 , wherein the cluster SCIT regimen comprises an up-titration regimen followed by a maintenance regimen, wherein the up-titration regimen comprises administering increasing doses of the grass extract over a period of 4 to 12 weeks and wherein the maintenance regimen comprises administering one or more maintenance doses of the grass extract at the highest dose administered during the up-titration regimen.
6. The method of claim 5 , wherein the up-titration regimen comprises administering increasing doses of the grass extract over a period of 8 weeks.
7. The method of claim 5 , wherein the maintenance regimen comprises administering maintenance doses every 1 to 4 weeks for at least 8 weeks.
8. The method of claim 5 , wherein the up-titration regimen comprises up-titrating from a dose of 1 bioequivalent allergy unit (BAU) to a dose of 4,000 BAU and wherein the maintenance regimen comprises administering one or more maintenance doses at 4,000 BAU.
9. The method of claim 1 , wherein the IL-4R antagonist is administered at a dose of about 75 mg to about 600 mg.
10. The method of claim 1 , wherein the IL-4R antagonist is administered as an initial dose followed by one or more secondary doses, wherein each secondary dose is administered 1 to 4 weeks after the immediately preceding dose.
11. The method of claim 10 , wherein the initial dose of the IL-4R antagonist is administered from 1 to 7 days before the start of the SCIT regimen.
12. The method of claim 10 , wherein the initial dose comprises 600 mg and each secondary dose comprises 300 mg of the IL-4R antagonist.
13. The method of claim 10 , wherein each secondary dose is administered 2 weeks after the immediately preceding dose.
14. The method of claim 1 , wherein the IL-4R antagonist and the SCIT are not administered to the subject on the same day.
15. The method of claim 1 , wherein enhancing the efficacy and/or tolerability of the SCIT regimen comprises reducing allergic rhinitis symptoms in the subject.
16. The method of claim 1 , wherein enhancing the efficacy and/or tolerability of the SCIT regimen comprises:
(a) increasing the amount of serum grass allergen-specific IgG4 (sIgG4) in the subject relative to SCIT monotherapy;
(b) decreasing the amount of serum grass allergen-specific IgE (sIgE) in the subject relative to SCIT monotherapy; and/or
(c) increasing the ratio of sIgG4 to sIgE in the subject relative to SCIT monotherapy.
17. The method of claim 1 , wherein administration of the IL-4R antagonist in combination with the SCIT regimen reduces or inhibits the induction of sIgE during the SCIT up-titration regimen and/or the SCIT maintenance regimen.
18. The method of claim 1 , wherein administration of the IL-4R antagonist in combination with the SCIT regimen increases the maximum SCIT dose that is tolerated by the subject.
19. The method of claim 1 , wherein administration of the IL-4R antagonist in combination with the SCIT regimen reduces the use of epinephrine or an oral steroid as a rescue medication.
20. The method of claim 1 , wherein the anti-IL-4R antibody or antigen-binding fragment thereof comprises three HCDRs (HCDR1, HCDR2 and HCDR3) and three LCDRs (LCDR1, LCDR2 and LCDR3), wherein the HCDR1 comprises the amino acid sequence of SEQ ID NO:3; the HCDR2 comprises the amino acid sequence of SEQ ID NO:4; the HCDR3 comprises the amino acid sequence of SEQ ID NO:5; the LCDR1 comprises the amino acid sequence of SEQ ID NO:6; the LCDR2 comprises the amino acid sequence of SEQ ID NO:7; and the LCDR3 comprises the amino acid sequence of SEQ ID NO:8.
21. The method of claim 1 , wherein the anti-IL-4R antibody or antigen-binding fragment thereof comprises a HCVR comprising the amino acid sequence of SEQ ID NO:1 and comprises a LCVR comprising the amino acid sequence of SEQ ID NO:2.
22. The method of claim 1 , wherein the anti-IL-4R antibody comprises a heavy chain comprising the amino acid sequence of SEQ ID NO:9 and a light chain comprising the amino acid sequence of SEQ ID NO:10.
23. The method of claim 1 , wherein the IL-4R antagonist is dupilumab or a bioequivalent thereof.
24. The method of claim 1 , wherein the IL-4R antagonist is contained in a container selected from the group consisting of a glass vial, a syringe, a pre-filled syringe, a pen delivery device, and an autoinjector.
25. The method of claim 24 , wherein the IL-4R antagonist is contained in a pre-filled syringe.
26. The method of claim 25 , wherein the pre-filled syringe is a single-dose pre-filled syringe.
27. The method of claim 24 , wherein the IL-4R antagonist is contained in an autoinjector.
28. The method of claim 24 , wherein the IL-4R antagonist is contained in a pen delivery device.