Dupilumab treatment led to clinical remission in patients with uncontrolled asthma
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Dupilumab treatment led to clinical asthma remission in patients with uncontrolled moderate-to-severe asthma with type 2 inflammation, according to a post hoc analysis of the LIBERTY ASTHMA QUEST study.
“Asthma remission represents a clinically meaningful goal for asthma management in the era of therapeutics that target underlying disease pathobiology; the medical community is still trying to understand what measures may best describe clinical remission in patients with asthma,” Ian Pavord, MD, professor of respiratory medicine at the NIHR Oxford Biomedical Research Centre at the University of Oxford, told Healio. “While there is no uniform definition of asthma remission, components that are commonly included in the definition are the absence of symptoms, lung function impairments and asthma attacks as well as the duration of these components.”
In the post hoc analysis presented at the virtual American Academy of Allergy, Asthma and Immunology Annual Meeting, clinical asthma remission was defined as experiencing no asthma exacerbations, as well as an Asthma Control Questionnaire (ACQ-5) score of less than 1.5 and post-bronchodilator FEV1 of at least 80%.
The analysis included 543 patients aged 12 years and older with uncontrolled moderate-to-severe asthma: 348 patients received dupilumab (Dupixent, Sanofi/Regeneron) 200/300 mg every 2 weeks and 195 patients received placebo. All patients had baseline post-bronchodilator FEV1 less than 80%, fractional exhaled nitric oxide level of at least 25 parts per billion and an eosinophil count of at least 150 cells/μL prior to treatment.
The researchers assessed the proportion of patients meeting the individual components and the composite endpoint of clinical asthma remission.
More patients assigned dupilumab were free from exacerbations at week 24 (83.3% vs. 61%) and also at week 52 (72.7% vs. 46.2%) compared with those assigned placebo, according to the abstract. A higher proportion of patients treated with dupilumab were exacerbation-free with an ACQ-5 score of less than 1.5 at week 24 (57.5% vs. 27.2%) and week 52 (43.1% vs. 21.5%) compared with the placebo group, according to the abstract.
The proportion of patients with clinical asthma remission was 29.6% in those treated with dupilumab compared with 8% of patients in the placebo group at week 24, Pavord said. At week 52, the proportion was 20.1% in the dupilumab group compared with 4.6% in the placebo group, according to the abstract.
The researchers also looked at outcomes in the overall intention-to-treat population in patients who did and did not achieve remission at week 24.
“Even in patients who did not meet these criteria, there was broad improvement in signs and symptoms of asthma,” Pavord told Healio.
Patients who did not achieve remission still had fewer asthma exacerbations (adjusted annualized rate of asthma exacerbations at week 24/week52: 0.63 vs. 1.51 for placebo at week 24; 0.56 vs. 1.46 for placebo at week 52) and had improved symptoms and lung function, Pavord told Healio.
“Dupilumab treatment could enable meaningful control of asthma symptoms, even in these patients with moderate to severe asthma who met none of the criteria for asthma remission at study entry,” Pavord said.
Future research is needed to further validate the definition of clinical remission, which is the subject of ongoing clinical and scientific debate, Pavord said.