A recent study has found that dupilumab significantly decreased the mucus plug score and improved lung function in patients with moderate-to-severe asthma, mainly in those with a high burden of mucus plugs at baseline. Chronic mucus hypersecretion plays an important role in airway obstruction and persistent inflammation, thus it is a key target for therapy in asthma management. VESTIGE was a study aimed at assessing how dupilumab affects airway mucus plugs, FeNO, and lung function, stratified by baseline scores. The study was conducted by Celeste P. and colleagues published in the American Journal of Respiratory and Critical Care Medicine.
The VESTIGE study (NCT04400318) enrolled 109 adults with moderate-to-severe asthma, baseline blood eosinophils ≥300 cells/μL, and FeNO ≥25 ppb. Patients were randomized to receive dupilumab 300 mg (n = 72) or placebo (n = 37) every 2 weeks for 24 weeks. Baseline mucus plug scores were derived from HRCT scans, with a high score ≥4 and low score 0–3.5. Post hoc analyses examined changes in mucus plug score, proportion of patients achieving FeNO <25 ppb, and changes in percent predicted FEV1 and FVC stratified by baseline mucus plug burden.
Results
Mucus Plug Discharge
FeNO Achievement
Dupilumab recipients were more likely than placebo recipients to achieve FeNO <25 ppb in both high and low-mucus plug subgroups:
Improving Lung Function
In patients with high baseline mucus plug scores, dupilumab significantly improved:
Pre- and post-bronchodilator FEV1: LSMD 16.77 percentage points [95% CI: 9.81–23.73; P <0.0001] and 12.70 [3.87–21.52; P = 0.0055], respectively
Pre-bronchodilator FVC: LSMD 0.42 mL [95% CI: 0.17–0.66; P = 0.001]
Post-bronchodilator FVC: LSMD 0.30 mL [95% CI: 0.01–0.59; P = 0.0399]
In adults with moderate-to-severe asthma, dupilumab significantly reduced mucus plug scores, improved lung function, and increased the probability of achieving FeNO <25 ppb, which underlines its efficacy for airway obstruction and inflammation, particularly in patients with a high baseline mucus plug burden.
Reference:
Porsbjerg, C., Dunican, E. M., Lugogo, N. L., Castro, M., Papi, A., Backer, V., Brightling, C. E., Bourdin, A., Virchow, J. C., Zhang, M., Soler, X., Rowe, P. J., Deniz, Y., de Prado Gómez, L., Sacks, H. J., & Jacob-Nara, J. A. (2025). Effect of dupilumab on mucus burden in patients with moderate-to-severe asthma: The VESTIGE trial. American Journal of Respiratory and Critical Care Medicine, rccm.202410-1894OC. https://doi.org/10.1164/rccm.202410-1894OC
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.