Dupilumab Plus Medium-Dose Inhaled Corticosteroid Improved Lung Function and Asthma Control, According to New Data

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Patients with asthma who received dupilumab plus medium-dose inhaled corticosteroid (ICS) had improved lung function and asthma control compared with those who received placebo plus high-dose ICS, according to new research presented at the 2024 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI).

The findings come from a post hoc analysis of the QUEST clinical trial, which evaluated the efficacy of dupilumab in participants aged 12 years and older with persistent asthma.

“Studies suggest a limited clinical benefit of escalating from medium- to high-dose ICS in patients with asthma. In QUEST, dupilumab improved lung function and asthma control for patients with moderate-to-severe asthma and was well tolerated,” wrote presenting author William Busse, MD, of the University of Wisconsin School of Medicine and Public Health, and colleagues.

Busse and coauthors conducted the current post hoc analysis to assess potential advantages of add-on dupilumab over ICS dose escalation. They compared clinical outcomes in participants enrolled in the QUEST study receiving add on dupilumab plus medium-dose ICS (D+mICS) or placebo plus high-dose ICS (P+hICS), according to the abstract.

In the QUEST trial, patients received either 500–1000 µg of medium-dose ICS per day or >1000 µg of high-dose ICS per day “and additional long-acting ß2-agonists +/- a third controller at baseline,” wrote investigators. Participants also received add-on dupilumab 200/300 mg once every 2 weeks or volume-matched placebo for 52 weeks.

“We assessed least squares mean difference from baseline in pre-bronchodilator FEV1 at Week 12 and the proportion of patients achieving asthma control (asthma control questionnaire-5 [ACQ-5] <1.5) at Week 52 with D+mICS or P+hICS,” added researchers.

According to the abstract, there were 513 participants in the D+mICS group and 287 individuals in the P+hICS group.

Results showed that in both the D+mICS group and P+hICS arm, baseline mean pre-bronchodilator FEV1 values were 1.91 L and 1.71 L. At week 12, researchers observed that compared to participants in the P+hICS group, pre-bronchodilator FEV1 among those in the D+mICS group improved by 0.15 L (95% CI, 0.21– 0.10; P < .001).

In addition, the number of patients at baseline achieving asthma control (ACQ-5 <1.5) was 1 for the D+mICS arm and 3 for the P+hICS arm. At week 52, investigators found higher proportions of patients receiving D+mICS (71%) than receiving P+hICS (51%) achieved asthma control (OR, 2.3, 95% CI 1.58-3.24).

Source: Busse W, Castro M, Lugogo N et al. Asthma treatment with add-on dupilumab plus medium-dose inhaled corticosteroid (ICS) improved lung function and asthma control compared with placebo plus high-dose ICS. J Allergy Clin Immunol. 2024;153:AB368. doi:10.1016/j.jaci.2023.11.878