Asthma Exacerbations and Systemic Corticosteroid Use Reduced With Dupilumab

Asthma exacerbations and systemic corticosteroid (SCS) prescriptions are significantly reduced in patients who receive dupilumab vs patients who receive omalizumab, benralizumab, or mepolizumab, according to study findings presented at the American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting, held from November 10 to 14, 2022, in Louisville, Kentucky.

Researchers conducted an exploratory review and analysis of US electronic medical record (EMR) data that included patients (N=5361) aged at least 12 years with an asthma diagnosis. Participants initiated dupilumab (n=2138), omalizumab (n=1313), benralizumab (n=918), or mepolizumab (n=992) between November 2018 and September 2020 and had 12 months pre- and post-index data. The primary outcome was to compare dupilumab, benralizumab, and mepolizumab in patients with at least 2 pre-index exacerbations.

Each of the comparison cohorts had inverse probability treatment weighting applied. Negative binomial regression models were used to analyze asthma exacerbations and SCS prescription orders. The researchers performed pairwise comparisons between dupilumab and omalizumab, benralizumab, or mepolizumab. Potential residual confounding in all models was adjusted for with doubly robust estimation.

At least 2 exacerbations in dupilumab (825), benralizumab (461), and mepolizumab (451) were observed among all patients during the pre-index period. The number of patients receiving omalizumab with at least 2 exacerbations pre-index was not mentioned. Dupilumab significantly reduced exacerbations in the post-index period (P <.0001) by 44% vs omalizumab, 24% vs benralizumab, and 28% vs mepolizumab.

There was a significant reduction in SCS prescriptions in the post-index period with dupilumab treatment by 28% vs omalizumab, 16% vs benralizumab, and 25% vs mepolizumab.

Limitations of the study include the use of EMR data.

The study authors conclude, “This exploratory EMR study demonstrated a significantly greater reduction in asthma exacerbations and SCS prescription in patients prescribed with dupilumab vs those on omalizumab, benralizumab, or mepolizumab.”