Severe Asthma Exacerbation Rates Appear Lower With Dupilumab Than Other Biologics

Dupilumab was associated with lower rates of severe asthma exacerbations and greater lung function gains than other biologic treatments in patients with uncontrolled persistent asthma, according to an indirect treatment comparison published in Respiratory Medicine.

“Currently, five biologic treatment options are available for use in patients with uncontrolled persistent asthma: three interleukin (IL)-5 antagonists, which either bind to the anti-IL-5 ligand (mepolizumab, reslizumab) or to the IL-5 receptor (benralizumab); one anti-immunoglobulin E (anti-IgE) therapy (omalizumab); and one anti-IL-4/IL-13 therapy (dupilumab),” researchers explained in the study background. “To date, no comparative data from head-to-head clinical trials are available for these biologics.”

The analysis included data from 14 randomized controlled trials that involved patients with persistent uncontrolled asthma using at least a medium- to high-dose inhaled corticosteroid plus a long-acting β2-agonist with add-on biologic therapy. Researchers looked at the effect of dupilumab compared with mepolizumab, reslizumab, benralizumab, and omalizumab for two endpoints: annualized severe asthma exacerbation rates and change in pre-bronchodilator forced expiratory volume in 1 second (FEV₁).

Reductions in annualized severe exacerbation rates associated with dupilumab were 54% greater than with benralizumab, 38% greater than with reslizumab, 28% greater than with mepolizumab, and 26% greater than with omalizumab, according to the study. Dupilumab was also associated with more FEV₁ improvement at week 12 and/or week 24/52 compared with the other biologic treatments.

“In the absence of any head-to-head trials, our analysis may be useful to clinicians and decision-makers considering these treatments for patients with uncontrolled persistent asthma,” researchers wrote.

Reference:
Bateman ED, Khan AH, Xu Y, et al. Pairwise indirect treatment comparison of dupilumab versus other biologics in patients with uncontrolled persistent asthma. Respir Med. 2022;191:105991. doi:10.1016/j.rmed.2020.105991