Dupilumab reduced impact of severe exacerbations on lung function in patients with moderate-to-severe type 2 asthma

Abstract

Severe asthma exacerbations increase the risk of accelerated lung function decline. This analysis examined the effect of dupilumab on forced expiratory volume in 1 s (FEV) in patients with moderate-to-severe asthma and elevated type 2 biomarkers from phase 3 LIBERTY ASTHMA QUEST (NCT02414854). Changes from baseline in pre- and post-bronchodilator (BD) FEV and 5-item Asthma Control Questionnaire (ACQ-5) scores were assessed in patients with elevated type 2 biomarkers at baseline (type 2-150/25: eosinophils ≥150 cells/μl and/or fractional exhaled nitric oxide [FeNO] ≥25 ppb; type 2-300/25: eosinophils ≥300 cells/μl and/or FeNO ≥25 ppb), stratified as exacerbators (≥1 severe exacerbation during the study) or non-exacerbators. In exacerbators and non-exacerbators, dupilumab increased pre-BD FEV by Week 2 vs placebo; differences were maintained to Week 52 (type 2-150/25: LS mean difference (LSMD) vs placebo: 0.17 L (95% CI: 0.10-0.24) and 0.17 L (0.12-0.23); type 2-300/25: 0.22 L (0.13-0.30) and 0.21 L (0.15-0.28)), in exacerbators and non-exacerbators, respectively (p < .0001). Similar trends were seen for post-BD FEV. Dupilumab vs placebo also showed significantly greater improvements in post-BD FEV 0-42 days after first severe exacerbation in type 2-150/25 (LSMD vs placebo: 0.13 L [0.06-0.20]; p = .006) and type 2-300/25 (0.14 L [0.06-0.22]; p = .001) patients. ACQ-5 improvements were greater with dupilumab vs placebo in both groups. Dupilumab treatment led to improvements in lung function independent of exacerbations and appeared to reduce the impact of exacerbations on lung function in patients who experienced a severe exacerbation during the study. This analysis assessed the effect of dupilumab on FEV in QUEST patients with moderate-to-severe asthma and elevated type 2 biomarkers. Dupilumab significantly increased FEV, regardless of number of severe exacerbations; FEV recovery was more rapid in dupilumab- vs placebo-treated patients. Dupilumab produced rapid and sustained improvement in lung function, including in patients experiencing severe exacerbations.Abbreviations: ACQ-5, 5-item Asthma Control Questionnaire; BD, bronchodilator; BL, baseline; FeNO, fractional exhaled nitric oxide; FEV, forced expiratory volume in 1 second; LS, least squares; q2w, every 2 weeks.