Achieving long-term, on-treatment clinical asthma remission with dupilumab treatment
Published online October 15, 2024
Asthma is a chronic respiratory condition characterized by inflammation and airway narrowing. Advancements in asthma therapies, including personalized treatment with biologics, have enhanced symptom management and shifted the goals toward achieving long-term disease control and clinical remission. Dupilumab, a monoclonal antibody that blocks the shared receptor component for type 2 inflammatory cytokines interleukin-4 and interleukin-13, has shown long-term efficacy and safety in both adults and adolescents with uncontrolled asthma.
In a recent report in The Journal of Allergy and Clinical Immunology: In Practice, Pavord et al. used data from the QUEST clinical study and the TRAVERSE clinical continuation study to determine whether dupilumab is effective in helping patients with moderate-to-severe asthma achieve clinical remission while receiving treatment. In QUEST, patients with moderate-to-severe uncontrolled asthma aged 12 years and over received add-on dupilumab (200 or 300 mg) or placebo every 2 weeks for 52 weeks. Patients who completed QUEST and subsequently enrolled in TRAVERSE received dupilumab 300 mg every 2 weeks for up to 96 weeks. The authors assessed clinical remission at the end of QUEST (Year 1; or Week 52) and at Week 48 of TRAVERSE (Year 2 overall). Clinical remission was defined as achievement of all these 4 criteria: at least 12 months with no severe exacerbations, zero oral corticosteroid use, stabilized or improved lung function, and a patient-reported asthma control score <1.5.
The study included 1040 patients who received dupilumab and 544 who received placebo in QUEST; of those, 842 from the dupilumab group continued treatment and 437 from the placebo group began dupilumab treatment upon enrollment in TRAVERSE. Results showed that at Week 52, patients who received dupilumab were significantly more likely to meet all 4 remission criteria than patients on placebo; specifically, 37.2% of patients receiving dupilumab compared with 22.2% of patients on placebo met the clinical remission criteria at Week 52 of QUEST (P < 0.001). Among those that completed TRAVERSE (Year 2), the proportion of patients treated with dupilumab meeting all 4 criteria for clinical remission was higher at Week 48 of TRAVERSE than that at Week 52 of QUEST; by Week 48 of TRAVERSE, 42.8% of patients receiving dupilumab during both QUEST and TRAVERSE met all 4 clinical remission criteria, compared with 33.4% of patients who switched from placebo in QUEST to dupilumab in TRAVERSE. Additionally, 26.8% of patients receiving dupilumab in both studies met the 4 clinical remission criteria when evaluated at Year 1, Year 1.5, and Year 2 combined. These results confirm the long-term effectiveness of dupilumab in treating moderate-to-severe uncontrolled asthma. Targeted biologic therapies like dupilumab can notably improve disease management and patient quality of life, and, in turn, advance asthma treatment goals toward achieving sustained disease remission.
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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