Treatment with dupilumab was found to be associated with lower severe asthma exacerbation rates and greater improvements in lung function in patients with uncontrolled persistent asthma compared with treatment with benralizumab, mepolizumab, and reslizumab, according to study results published in Respiratory Medicine.
The study was an indirect treatment comparison (ITC) based on data from randomized controlled trials (RCTs) in which patients ≥12 years of age with uncontrolled persistent asthma were enrolled. Participants in RCTs selected for review were treated with a medium-to-high dose inhaled corticosteroid in combination with a long-acting β2-agonist with add-on biologic therapy. Bucher ITCs in which patients treated with dupilumab were compared with participants treated with mepolizumab, reslizumab, or omalizumab, – were conducted.
In total, 14 RCTs were included in the ITC analyses. Treatment with 200 mg and/or 300 mg dupilumab was associated with a lower severe asthma exacerbation rate compared with treatment with: benralizumab (exacerbation rate ratio [RR], 0.46; 95% CI, 0.32–0.67), mepolizumab (exacerbation RR, 0.72; 95% CI, 0.57–0.92), and with reslizumab (exacerbation RR, 0.62; 95% CI, 0.48–0.79).
Dupilumab treatment was also associated with greater improvement in forced expiratory volume in 1 second (FEV1) compared with treatment with: benralizumab at week 12 (mean difference, 0.12 L; 95% CI, 0.02–0.22) and week 24 (mean difference, 0.11 L; 95% CI, 0.01–0.21), and reslizumab at week 24 (0.14 L; 95% CI, 0.04–0.24). Improvements in FEV1 at week 12 and 24 were comparable in patients treated with 200 mg and/or 300 mg dupilumab vs mepolizumab (0.08 L; 95% CI, −0.08 to -0.24 and 0.09 L; 95% CI, −0.05 to -0.24, respectively).
Limitations of this analysis were the inclusion of studies with varying definitions of asthma exacerbations, the lack of data on patient-reported outcomes, and the sole inclusion of RCT data, which may not be applicable to clinical practice.
“[O]ur analysis may be useful to clinicians and decisionmakers considering these treatments for patients with uncontrolled persistent asthma,” concluded the study authors.
Disclosure: This clinical trial was supported by Sanofi and Regeneron Pharmaceuticals. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Bateman ED, Khan AH, Xu Y, et al. Pairwise indirect treatment comparison of dupilumab versus other biologics in patients with uncontrolled persistent asthma [published online April 29, 2020]. Respir Med. doi: 10.1016/j.rmed.2020.105991