Therapy Improves Type 2 Asthma Outcomes Regardless of Allergic Status

Patients with asthma with type 2 inflammation, with and without evidence of allergic asthma, had improved exacerbation rates, lung function, and asthma control with long-term dupilumab, according to study results published online ahead of print in Allergy.

“A post hoc analysis of QUEST patients showed dupilumab efficacy in patients with moderate-to-severe asthma with type 2 inflammation following the criteria outlined in the 2021 GINA [Global Initiative for Asthma] guidelines, with and without an allergic phenotype,” researchers wrote. “In this follow-up post hoc analysis, we aimed to evaluate the long-term efficacy of dupilumab in these subgroups of patients from QUEST who enrolled in TRAVERSE, for up to an additional 96 weeks.”

A total of 1530 patients rolled over from the placebo-controlled QUEST study to TRAVERSE and received add-on dupilumab 300 mg every 2 weeks for up to 96 weeks. 

Dupilumab consistently reduced asthma exacerbation rates across all patient subgroups, the analysis showed. 

Patients also showed gains in lung function. Between parent-study baseline and week 96, dupilumab increased pre-bronchodilator forced expiratory volume in 1 second (FEV1) from by 0.35–0.41 L in patients who received placebo during QUEST (placebo/dupilumab) and 0.34–0.44 L in patients who received dupilumab during QUEST (dupilumab/dupilumab) with an allergic phenotype. Pre-bronchodilator FEV1 increased 0.38–0.41 L with placebo/dupilumab and 0.33–0.37 L dupilumab/dupilumab in patients without evidence of allergic asthma.

Meanwhile, scores on the 5-item asthma control questionnaire between parent-study baseline and week 48 decreased 1.63 to 1.69 points with placebo/dupilumab and 1.74 to 1.81 points with dupilumab/dupilumab in subgroups of patients with allergic asthma. In subgroups without allergic asthma, scores decreased 1.75 to 1.83 with placebo/dupilumab and 1.78 to 1.86 with dupilumab/dupilumab.

“Furthermore,” researchers wrote, “the greater treatment effect in patients with elevated type 2 inflammatory biomarkers at baseline was sustained throughout the TRAVERSE open-label extension study and appeared to be mostly unaffected by the presence of an allergic phenotype.”

Reference: 
Rabe KF, Pavord ID, Busse WW, et al. Dupilumab improves long-term outcomes in patients with uncontrolled, moderate-to-severe GINA-based type 2 asthma, irrespective of allergic status. Allergy. Published online April 19, 2023. doi:10.1111/all.15747