Dupilumab outperforms mepolizumab and benralizumab in asthma

Published online April 16, 2025

Asthma is a chronic lung condition causing breathing difficulties, affecting millions worldwide. For severe cases, biological agents targeting specific immune pathways can reduce flare-ups, known as exacerbations. However, direct comparisons of their effectiveness have been limited.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Hung et al. compared three biologics—dupilumab, mepolizumab, and benralizumab—to determine which is most effective at preventing asthma exacerbations. They analyzed data from over 275 million patients across 21 countries, using the TriNetX database. The study included adults with asthma who started dupilumab, mepolizumab, or benralizumab between November 2018 and January 2024. The researchers tracked how long it took for patients to experience their first asthma exacerbation in over a year. The study balanced patient groups for factors like age, sex, and health conditions to ensure fair comparisons and examined subgroups based on blood eosinophil levels (a marker of inflammation), presence of chronic obstructive pulmonary disease (COPD), and past exacerbations.

Hung et al. found that dupilumab reduced the risk of asthma exacerbations by 32% compared to mepolizumab and 26% compared to benralizumab. The benefits were most significant in patients with high eosinophil counts (≥300 cells/µL), those with COPD, and those without prior exacerbations. Dupilumab also lowered the need for systemic corticosteroids, which are often used to manage severe asthma flare-ups. These findings suggest dupilumab may be a preferred choice for many patients with severe asthma, supporting personalized treatment plans.

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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