Dupilumab benefit persists regardless of age at asthma onset

NEW ORLEANS — In a post hoc analysis of the LIBERTY ASTHMA QUEST study, treatment with dupilumab reduced severe exacerbations and improved lung function regardless of early or late onset of asthma.

As age at asthma onset may determine the course of disease, associated comorbidities and response to therapy, researchers performed this analysis to evaluate the efficacy of dupilumab (Dupixent, Sanofi/Regeneron) in subgroups of patients with uncontrolled, moderate to severe asthma who were diagnosed with asthma within the first 40 years or life or after age 40 years.

Overall results of the phase 3 LIBERTY ASTHMA QUEST study showed significant reductions in severe exacerbation rates and improvements in pre-bronchodilator FEV₁ over 52 weeks with add-on dupilumab 200 mg or 300 mg every 2 weeks compared with placebo.

“In the new analysis, the magnitude of effect observed for severe asthma exacerbations was numerically greater in patients with late-onset asthma,” Nicola A. Hanania, MD, MS, associate professor and director of the Airways Clinical Research Center at Baylor College of Medicine and director of the Asthma and COPD Clinic at Ben Taub Hospital in Houston, said during a presentation at the CHEST Annual Meeting.

Compared with placebo, in the late-onset group the rate of severe exacerbations was reduced by 63.7% (P < .0001) with dupilumab 200 mg and 68.5% (P < .0001) with 300 mg, and in the early-onset group by 38% (P = .0009) and 37% (P = .0007), respectively, according to the new data.

However, Hanania reported that “greater treatment effects were observed in patients with elevated blood eosinophils or fractional exhaled nitric oxide in both groups.”

In patients with baseline eosinophils 150 cells/µL or greater, the rate of severe exacerbations was reduced by 50% with dupilumab 200 mg and 55% with 300 mg in those with asthma onset before age 40 years and by 65% and 68%, respectively, in those with later onset. In patients with fractional exhaled nitric oxide (FeNO) 20 ppb or greater, severe exacerbations were reduced by 56% with 200 mg and 52% with 300 mg in those with early-onset asthma and by 79% and 71%, respectively, in those with late-onset asthma, according to Hanania.

In a post hoc analysis of the LIBERTY ASTHMA QUEST study, treatment with dupilumab reduced severe exacerbations and improved lung function regardless of early or late onset of asthma.

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“The magnitude of effect observed for pre-bronchodilator FEV₁ was numerically similar in both groups,” he said. Again, greater effects were observed in those with elevated eosinophils and FeNO, he said.

“Dupilumab may benefit patients with either early – or late-onset asthma,” the researchers concluded. – by Katie Kalvaitis

Reference:

Hanania NA. Getting it right: Personalized strategies for better asthma control. Presented at: CHEST Annual Meeting; Oct. 19-23, 2019; New Orleans.

Disclosures: The LIBERTY ASTHMA QUEST study was funded by Sanofi and Regeneron. Hanania reports he has financial relationships with AstraZeneca, Boehringer Ingelheim, Genentech, GlaxoSmithKline, Mylan, Novartis, Regeneron, Sanofi and Sunovion.