Respiratory biologics are equally effective in reducing the most severe asthma exacerbations

Published: February 28, 2024

As more respiratory biologics gain approval for the treatment of asthma and with significant overlap in those eligible for two or more of these therapies, patients, providers, and other stakeholders are interested in their comparative effectiveness. Acute exacerbations of asthma is the most commonly used metric of therapeutic effectiveness in asthma. However, exacerbations requiring hospitalizations, although less frequent, are more costly than exacerbations not requiring hospitalizations and have higher potential for fatality.

In a recent issue of The Journal of Allergy and Clinical Immunology: In Practice, Akenroye et al. used data from the FDA’s Sentinel System and from administrative claims data to conduct pairwise comparisons of the effectiveness of omalizumab, mepolizumab, benralizumab, and dupilumab. Study participants were all adults aged 18 years or older with asthma who had initiated one of these biologics between 2018, following dupilumab approval, and 2023. They improved comparability among  the comparator groups using propensity-score matching of demographic variables, allergic comorbidities, including chronic rhinosinusitis with nasal polyposis, and the Charlson Comorbidity Index.

Dupilumab and benralizumab were associated with the lowest incidence of overall exacerbations over the follow-up period. However, when limited to exacerbations requiring hospitalizations, the differences between the groups were smaller. Mepolizumab and benralizumab were associated with the greatest reductions in asthma-related hospitalizations.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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