Decreased dupilumab dosing frequency associated with stable asthma control
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Key takeaways:
- 47.6% of patients tolerated changes in dosing from every 2 weeks to every 4 weeks.
- Patients who did not tolerate these changes switched back to every 2 weeks after an average of 119.11 days.
HONOLULU — Patients with well-controlled asthma who use dupilumab may tolerate a reduction in the frequency of their doses from every 2 weeks to every 4 weeks, according to a poster presented at the CHEST Annual Meeting.
However, more investigation is needed to determine the utility of this adjustment, Jessica E. Most, MD, critical care medicine specialist at Thomas Jefferson University Hospital, and colleagues wrote.
“We were hoping to provide patients with a similar medication effect with less-frequent injections. This provides less of a burden to patients and is less costly,” Most told Healio.
“Some of our patients experience less side effects when they use the medication less often,” she continued. “This is an added benefit besides that added convenience of less-frequent dosing.”
Current guidelines do not indicate how long patients with severe uncontrolled eosinophilic asthma should be on dupilumab (Dupixent; Regeneron, Sanofi), although guidelines do indicate that inhaled therapy can be decreased for patients with well-controlled asthma.
The study comprised 20 patients (75% female; mean age, 51.86 ± 17.99 years) with well-controlled asthma based on a mean Asthma Control Test score of 22.78 ± 2.42 and a mean FEV1 percentage of 86.6 ± 16.38. None of these patients had been hospitalized or had been to urgent care in the previous year.
Dupilumab dosing was changed from every 2 weeks to every 4 weeks because of clinical remission for 17 of the patients, adverse effects for 10% of the patients and loss of medication coverage, also for 10% of the patients.
During median follow-upof 239 days from the change in frequency, 47.6% of the patients tolerated the change based on subjective patient reports, maintenance of asthma control and absence of exacerbations, and they remained on the 4-week schedule.
Three patients (15%) experienced exacerbations that were secondary to upper respiratory infections and required oral corticosteroids. The patients who were deemed intolerant had subjective worsening of their asthma symptoms and returned to a 2-week schedule in an average 119.11 ± 48.47 days.
“It is interesting that almost half of our patients preferred to use the standard dupilumab dosing. They had a subjective worsening of their symptoms when they were on every-4-week dosing,” Most said. “This highlights that our objective measures for asthma control do not fully capture asthma burden.”
Based on these findings, the researchers said that patients taking dupilumab for their well-controlled asthma may be able to tolerate a reduction in frequency to every 4 weeks, but the usefulness of these reductions requires additional study.
“We would like to identify if there are patient characteristics that predict whether or not a patient could tolerate less-frequent dupilumab dosing,” Most said.
For more information:
Jessica E. Most, MD, can be reached at jessica.most@jefferson.edu.
Perspective
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The small sample size makes broad generalizations regarding dosing challenging. However, it is not surprising, given the heterogeneity of asthmatics, that almost half of the patients tolerated less-frequent dosing. Given the high cost of biologics and the need for injections, these data are promising and warrant further study.
To improve care, doctors can consider alternative dosing schedules for patients who are unable to tolerate biweekly injections. As a next step in this research, a larger scale, prospective study looking at the optimal dosing intervals would be the next course of action.
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