Most asthma biologics have similar efficacy in patients with, without allergy

Key takeaways:

• The efficacy of mepolizumab, benralizumab and tezepelumab was similar in patients with vs. without allergy.
• Lower efficacy in patients with allergy was found with 200 mg dupilumab.

WASHINGTON — Allergic status did not impact annualized asthma exacerbation rate reductions seen with mepolizumab, benralizumab and tezepelumab in patients with moderate to severe, uncontrolled asthma, according to study results.

However, patients with vs. without allergy receiving a 200 mg dose of dupilumab (Dupixent; Regeneron, Sanofi) had a smaller reduction in exacerbations, according to researchers.

These data on mepolizumab (Nucala, GSK), benralizumab (Fasenra, AstraZeneca), tezepelumab (Tezspire; Amgen, AstraZeneca) and dupilumab efficacy were presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“The selection of a biologic for treatment of moderate to severe asthma requires using other clinical criteria to determine the reason for selecting a biologic,” Jonathan A. Bernstein, MD, FAAAAI, FACAAI, FACP, of Bernstein Allergy Group, told Healio.

“Dupilumab may be more effective in patients with high FeNO, whereas mepolizumab and benralizumab are more effective in patients with higher eosinophil counts (> 150 cells/µL), and tezepelumab may be useful in low and high eosinophil [counts] in patients with or without allergy,” Bernstein, who is also an adjunct professor at University of Cincinnati College of Medicine, continued.

Using PubMed, Bernstein and colleagues found and reviewed seven phase 3 randomized controlled trials evaluating the use of mepolizumab, benralizumab, tezepelumab or dupilumab in patients with moderate to severe, uncontrolled asthma in order to determine the impact of allergy status on annualized asthma exacerbation rate reductions with each biologic.

Researchers noted that the included trials had varying criteria for determining allergic status.

The MENSA/MUSCA trial looked at the performance of 100 mg mepolizumab every 4 weeks (n = 274 with allergy; n = 633 without allergy), the SIROCCO/CALIMA trial looked at 30 mg benralizumab every 8 weeks (n = 1,375 with allergy; n = 883 without allergy), the NAVIGATOR/PATHWAY trial looked at 210 mg tezepelumab every 4 weeks (n = 815 with allergy; n = 484 without allergy) and the LIBERTY ASTHMA QUEST trial looked at 300 mg dupilumab (n = 540 with allergy; n = 414 without allergy), as well as a 200 mg dose every 2 weeks (n = 543 with allergy; n = 405 without allergy).

When compared with patients receiving placebo, patients receiving mepolizumab, benralizumab, dupilumab or tezepelumab all had a reduction in exacerbations. This finding was true in both those with allergy and those without allergy, according to researchers.

In terms of efficacy, researchers observed comparable annualized asthma exacerbation rate reductions between patients with vs. without allergy receiving mepolizumab (difference, –1%), benralizumab (–6%), 300 mg dupilumab (–8%) and tezepelumab (+8%).

Notably, patients with allergy vs. without allergy receiving the 200 mg dose of dupilumab had a smaller decrease in the annualized asthma exacerbation rate (difference, –29%).

“In general, these findings are not surprising as the immunologic pathways involved in asthma that are targeted by these biologics are relevant in allergic and nonallergic patients,” Bernstein told Healio. “The lower dose of dupilumab result is interesting, but [it’s] hard to determine the clinical relevance of this finding.”

When asked about future studies, Bernstein said real world studies could be useful.

“It is unlikely head-to-head studies will be done; real world studies that capture these clinical characteristics could shed light on this observation,” he said.

Reference:

Bernstein JA, et al. J Allergy Clin Immunol. 2024;doi:10.1016/j.jaci.2023.11.338.