Tezepelumab and dupilumab effective at reducing asthma exacerbations in patients with eosinophilia

Ontario: New trial from Ontario revealed that biologics like Tezepelumab and dupiliumab can successfully reduce exacerbations in asthma patients by improving lung function. The trial results were published in the journal Annals of Allergy, Asthma & Immunology. 

Asthma is a respiratory condition that is associated with significant morbidity. Asthma that is inadequately controlled by high-dose inhaled corticosteroids and long-acting β2-agonists or oral corticosteroids may have an advantage from using biologics. Though there is data on the use of biologics for asthma, no trial has directly compared biologics to manage uncontrolled asthma. Hence Tyler Pitre et al from Ontario, Canada have conducted a trial to compare the relative efficacy of biologics in asthma. 

Randomized trials that addressed biologic therapies were included from inception to May 31, 2022. The researchers independently screened references, extracted data, and assessed the risk of bias. A frequentist network meta-analysis was performed, and certainty of evidence was assessed using the GRADE approach. Dichotomous outcomes were presented as absolute risk differences per 1000 patients and relative risk (RR) with 95% confidence intervals (95% CI) and continuous outcomes were presented as mean difference (MD) and 95% CI. 

Key findings of the study: 

•  64 trials, including 26,630 patients were included.
• Tezepelumab showed 329 fewer exacerbations per 1000 and dupilumab showed 319.6 fewer exacerbations per 1000 compared to the placebo (high certainty) in patients with eosinophilic asthma. 
• Tezepelumab (MD 0.24 L) and dupilumab (0.25 L) improved lung function (FEV1) compared to the placebo with high certainty.
• When compared to placebo both Tezepelumab (110.97 fewer hospital admissions per 1000) and dupilumab (97.27 fewer hospitalizations) reduced hospital admissions with moderate certainty.
• Biologics could not improve asthma outcomes in low eosinophilic patients.
• Tezepelumab (MD 0.1 L) and dupilumab (MD 0.1 L) improved lung function with low certainty for the low eosinophilic patients. 

Thus, though all available biologics are effective at reducing exacerbations, Tezepelumab and dupiliumab reduce exacerbations by improving lung function as compared to other available treatments.