Dupilumab Plus Medium-Dose Inhaled Corticosteroid Improves Lung Function, Asthma Control: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study presented at the 2024 Annual Meeting of the American Academy of Allergy, Asthma & Immunology.

The study

Researchers conducted 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.

The current post hoc analysis was conducted to assess potential advantages of add-on dupilumab over inhaled corticosteroid (ICS) dose escalation. Investigators 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).

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.

There were 513 participants in the D+mICS group and 287 individuals in the P+hICS group.

The findings

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).

Authors' comment

"Patients receiving D+mICS had improved lung function and asthma control vs those on continued therapy with P+hICS."

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