Prospective direct comparison of biological treatments on severe eosinophilic asthma: Findings from the PRISM study

Duong Duc Pham, Ji Hyang Lee, Hyouk Soo Kwon, Woo Jung Song, You Sook Cho, Hyunkyoung Kim, Jae Woo Kwon, So Young Park, Sujeong Kim, Gyu Young Hur, Byung Keun Kim, Young Hee Nam, Min Suk Yang, Mi Yeong Kim, Sae Hoon Kim, Byung Jae Lee, Taehoon Lee, Min Hye Kim, Young Joo Cho, Chan Sun ParkJae Woo Jung, Han Ki Park, Joo Hee Kim, Ji Yong Moon, Pankaj Bhavsar, Ian Adcock, Kian Fan Chung, Tae Bum Kim

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Although various monoclonal antibodies have been used as add-on therapy for eosinophilic severe asthma (ESA), no direct head-to-head comparative study has evaluated their efficacies. Objective: To compare the efficacy of reslizumab, mepolizumab, and dupilumab in patients with ESA through a multicenter, prospective, observational study. Methods: A total of 96 patients with ESA who had received one of these biological agents for at least 6 months were included in the study. Cox proportional hazard models were used to compare the risk of the first exacerbation event. The annual exacerbation rate was analyzed using a negative binomial model, and a mixed-effect model was used to analyze changes in forced expiratory volume in 1 second and asthma control test score over time. Results: In comparison to reslizumab adjusted for sputum eosinophils and common asthma-related covariates, the hazard ratios and 95% confidence intervals of the first exacerbation incidence were 2.90 (0.92-9.16) and 2.69 (0.87-8.29) for dupilumab and mepolizumab, respectively. During the follow-up period, the dupilumab group was more likely to experience exacerbation compared with the reslizumab group (rate ratio and 95% confidence interval, 3.97 [1.17-14.74]). No differences were observed when the models were adjusted for blood eosinophil counts. Both the forced expiratory volume in 1 second and asthma control test improved after treatment, but no group differences were found. Conclusion: Three biologics were equally effective as add-on therapy for ESA. Reslizumab may have an advantage in preventing future exacerbation compared with dupilumab. Sputum eosinophils may be a useful consideration when choosing a biological treatment.

Original languageEnglish
JournalAnnals of Allergy, Asthma and Immunology
DOIs
StateAccepted/In press - 2023

Bibliographical note

Publisher Copyright:
© 2023 American College of Allergy, Asthma & Immunology

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