Study Compares Dupilumab Against Other Biologics for Asthma

A study presented at this year's American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Louisville, Kentucky, compared the real-world effectiveness of dupilumab versus omalizumab, benralizumab, and mepolizumab for patients with asthma, and found that dupilumab was linked to significantly lower exacerbations and reduced prescriptions of systemic corticosteroid (SCS) compared with the other therapies.

The Global Initiative for Asthma (GINA) guidelines recommend considering add-on type-2-targeted biologics for patients with uncontrolled asthma despite receiving corticosteroids or long-acting beta-agonists, but the researchers wrote that there is a lack of head-to-head comparison studies. Moreover, the biologics that are available have different mechanisms of action, which make it challenging for clinicians to optimize therapy.

The US ADVANTAGE study used electronic medical record (EMR) data from the TriNetXAnalytics Network, a nationwide research network that contains aggregated, de-identified health record data from several health care organizations.

The index date was defined as the initiation of dupilumab, omalizumab, benralizumab, or mepolizumab for asthma between November 2018 and September 2020, and the index biologic was the first biologic begun in that timeframe.

Outcomes were defined as the annualized rate of severe asthma exacerbation, defined as an outpatient or emergency room visit with asthma diagnosis recorded, and at least 1 dispensing of SCS within 5 days before or after the encounter; or hospitalization with asthma as a primary diagnosis. Another outcome measure was the annualized rate of SCS use.

The statistical analysis included pairwise comparisons of annualized rate of asthma exacerbation among patients starting dupilumab versus omalizumab, benralizumab, or mepolizumab, respectively. Similar pairwise comparisons were performed for SCS use in the post-index period. In addition, inverse probability of treatment weighting (IPTW) was used to account for potential confounding in treatment groups, and negative binomial regression models weighted by the stabilized weights were used to estimate the incidence rate ratio (IRRs) of asthma exacerbation comparing patients receiving dupilumab to patients receiving other biologics in the observation period

A total of 21,704 patients with asthma were identified from the database. The analysis included 2138 patients on dupilumab,1313 on omalizumab, 918 on benralizumab and 992 on mepolizumab. Patients were aged 12 and above.

Dupilumab, benralizumab, and mepolizumab were compared in patients with ≥2 pre-index exacerbations. In total, 825 patients who were prescribed dupilumab had ≥2 pre-index exacerbations whereas 461 patients who were prescribed benralizumab and 451 patients who were prescribed mepolizumab also experienced ≥2 pre-index exacerbations.

Results showed:

• Dupilumab significantly (P <.0001) reduced exacerbations [(1-IRR) *100] by 44% versus omalizumab, according to IPTW analyses of asthma exacerbations.
• In patients with ≥2 asthma exacerbations during the baseline period, dupilumab significantly (P <.0001) reduced exacerbations by 24% versus benralizumab, and 28% versus mepolizumab.
• Dupilumab significantly (P <.05) reduced SCS prescriptions by 28% versus omalizumab, 16% versus benralizumab, and 25% versus mepolizumab in the 12-month observation period

The study was funded by Sanofi and Regeneron Pharmaceuticals.

Reference

Bleeker ER, Blaiss M, Jacob-Nara J, et al. Real-world effectiveness of dupilumab and other biologics on asthma exacerbations and steroid prescriptions: US ADVANTAGE study. Presented at: ACAAI 2022 Annual Scientific Meeting; November 10-14, 2022; Louisville, KY. Abstract P089.