Biologics in Eosinophilic Asthma: Dupilumab vs Mepolizumab vs Benralizumab

A comparison of dupilumab, mepolizumab, and benralizumab for the treatment of eosinophilic asthma showed that the effectiveness and safety of the various biologics differed depending upon the patient’s eosinophil levels. Study findings were presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting, held in Phoenix, Arizona, February 25 to 28.

To evaluate the relative effectiveness of biologics in asthma treatment, study investigators conducted a Bayesian network meta-analyses comparing dupilumab, mepolizumab, and benralizumab efficacies in a placebo-controlled study. The analysis study included data from 5845 individuals from 7 trials. Participant data were divided into 2 groups for analysis: data from those with eosinophil counts 150-299 cells/mm³; and data from those with eosinophil counts of 300 cells/mm³ or greater. Data analysis estimated mean differences from baseline in prebronchodilator forced expiratory volume in the first second (FEV₁) and asthma control questionnaire (ACQ) scores, as well as relative risks of exacerbations.

Among individuals with eosinophil counts of 300 cells/mm³ or greater, the analysis found that relative risks of exacerbations compared to placebo were as follows: dupilumab 0.31 (95% credible interval [CrI], 0.16-0.58); mepolizumab 0.36 (95% CrI, 0.20-0.65); benralizumab 0.51 (95% CrI, 0.34-0.81). Compared to placebo, the largest increase in FEV₁ among individuals with eosinophil counts of 300 cells/mm³ or greater was seen in participants using dupilumab (+230ml) vs benralizumab (+150ml) vs mepolizumab (+140ml). Only mepolizumab showed improvements in ACQ scores among those with eosinophil counts of 300 cells/mm³ or greater. Researchers concluded that in those with eosinophil counts of 300 cells/mm³ or greater, dupilumab ranked highest in reducing exacerbations and improving lung function, and that mepolizumab was most successful for improvements in ACQ scores.

In individuals with eosinophils 150-299 cells/mm³, mepolizumab proved best in improving lung function, and both benralizumab and dupilumab had slightly higher relative risks than mepolizumab.

Researchers concluded, “In patients with eosinophilic asthma, varying eosinophilic count thresholds and the outcome of interest should influence the biologic choice.”

Reference

Akenroye A, Lassiter G, Jackson J, et al. Effectiveness of mepolizumab, benralizumab, and dupilumab in eosinophilic asthma: A Bayesian network meta-analysis. Presented at: American Academy of Allergy, Asthma & Immunology (AAAAI) 2022 Annual Meeting; February 25–28, 2022; Phoenix, AZ. Abstract 444.