Real-world effectiveness of dupilumab in patients with asthma: Findings from the US ADVANTAGE study

Dupilumab is approved as an add-on maintenance therapy for patients (≥6 years) with moderate-to-severe asthma. Better understanding of real-world effectiveness is needed.The United States (US) ADVANTAGE study aimed to characterize the real-world effectiveness of dupilumab in asthma management.This retrospective study included patients (≥12 years of age) diagnosed with asthma, initiating dupilumab between November 2018 and September 2020. The study used a US electronic medical record database (TriNetX Dataworks, Cambridge, MA, USA). Asthma exacerbation rates before and after the initiation of dupilumab were analyzed using generalized estimating equations models with Poisson probabilistic link to estimate incidence rate ratios (IRRs). Sensitivity analyses were conducted based on previous exacerbation data, eosinophil (EOS) levels, history of atopic dermatitis or chronic rhinosinusitis with nasal polyps, prior use of biologics, and presence of SARS-CoV-2 (COVID-19).A total of 2,400 patients initiating dupilumab met all study criteria. After initiation of dupilumab, risk of asthma exacerbation was reduced by 44% (IRR: 0.56, 95% confidence interval [CI]: 0.47-0.57, P = <0.0001) and systemic corticosteroid (SCS) prescriptions were reduced by 48% (IRR: 0.52 95% CI: 0.48, 0.56, P = <0.0001) compared with that prior to initiation of dupilumab. Adjustment for COVID-19 showed a greater reduction in asthma exacerbations (IRR 0.50, 95% CI: 0.45-0.55, P = <0.0001).Current real-world efficacy evidence indicates that dupilumab reduces asthma exacerbations and total SCS prescriptions in clinical practice. The effectiveness of dupilumab was observed independent of exacerbation history, EOS levels, or COVID-19 impact.