Dupilumab outperforms other biologics in severe asthma treatment
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Key takeaways:
- The cohort included patients aged 12 years and older diagnosed with severe asthma.
- There were lower incidence rate ratios for oral corticosteroid prescriptions with dupilumab compared with other biologics.
Dupilumab was more effective than omalizumab, benralizumab and mepolizumab in treating patients with severe asthma, according to a pair of abstracts presented at European Respiratory International Congress.
“Both dupilumab and omalizumab are approved for certain patients with asthma in the EU, but there is limited understanding of how these two biologics compare in terms of efficacy, as there are no head-to-head controlled studies,” Giorgio Walter Canonica, MD, of the department of personalized medicine, asthma and allergy, Humanitas Clinical and Research Center, told Healio.
“We used real-world data from clinical use of the medicines in the EU to determine if patients had differing outcomes,” he continued.
EU-ADVANTAGE collected data from the medical charts of patients aged 12 years and older with physician-confirmed severe asthma treated with dupilumab (Dupixent; Regeneron, Sanofi), omalizumab (Xolair; Genentech, Novartis), benralizumab (Fasenra; AstraZeneca) or mepolizumab (Nucala; GSK) as an add-on maintenance therapy.
Average exposure times to these biologics included 11.5 months for dupilumab (n = 1,281; 61.3% male) and 11.4 months for omalizumab (n = 638; 60.4% male), benralizumab (n = 406; 60.1% male), and mepolizumab (n = 414; 60.3% male) alike.
Incidence rate ratios (IRRs) for asthma exacerbations for dupilumab in the 12 months that followed the index date included 0.78 (95% CI, 0.64-0.96) compared with omalizumab; 0.77 (95% CI, 0.6-0.98) compared with mepolizumab; and 0.65 (95% CI, 0.5-0.84) compared with benralizumab.
The researchers defined exacerbations as the use of systemic corticosteroids for 3 to 14 days or a hospitalization or ED visit with asthma as a primary diagnosis.
Similarly, IRRs for oral corticosteroid prescriptions for dupilumab in the 12 months following the index date included 0.75 (95% CI, 0.63-0.9); compared with omalizumab, 0.79 (95% CI, 0.68-0.93) compared with mepolizumab; and 0.73 (95% CI, 0.62-0.86) compared with benralizumab.
“These results are consistent with previous real-world studies in the U.S.,” Canonica said. “The consistency across geographies further supports the benefit of dupilumab over omalizumab in reducing exacerbations and [oral corticosteroid] use for certain patients with asthma.”
Despite these significant differences, the researchers cautioned that residual confounding caused by clinical characteristics that were not measured still may be present. However, the researchers said these findings still can impact practice.
“These findings have implications for physicians when selecting a biologic for severe asthma,” Canonica said. “For eligible patients, dupilumab may reduce both disease and treatment burden compared to other available biologics.”
Although the study is complete, Canonica continued, researchers are not done with the findings.
“We will continue to analyze data from the EU-ADVANTAGE study and also assess how dupilumab impacts patients in real-world settings across geographies in other studies,” Canonica said.
Reference:
- Virchow JC, et al. Abstract 44110. Presented at: European Respiratory Society International Congress; Sept. 7-11, 2024; Vienna.
Perspective
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The data are interesting, and it is important to do real world studies. However, it is hard to draw firm conclusions from these abstracts, as these data are limited by the retrospective, non-placebo-controlled, nonrandomized aspect of the analysis, as well as prescription bias. Ideally, one would need to identify subjects eligible for each therapy and do a prospective randomized study. Furthermore, some therapies are better for some patients compared with others.
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Canonica GW, et al. Abstract 44109. Presented at: European Respiratory Society International Congress; Sept. 7-11, 2024; Vienna.
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