Guillaume Germain, Emmeline Burrows, Jacob Klimek, Patrick Gravelle, François Laliberté, Arijita Deb
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引用次数: 0
Abstract
Introduction: Mepolizumab and dupilumab are biologic therapies used to manage uncontrolled asthma, though direct comparative real-world evidence between these two agents is limited. This study compared asthma-related hospitalizations and asthma exacerbations between mepolizumab and dupilumab among an older and clinically complex population of Medicare fee-for-service (FFS) beneficiaries with asthma.
Methods: Data from Komodo Research Database (01/01/2018-05/31/2025) were used to identify Medicare FFS beneficiaries with asthma and a first claim for mepolizumab or dupilumab on or after January 1, 2019 (index date), as well as a subgroup of patients adherent to the index biologic for ≥ 6 months. Cohorts were balanced using overlap weighting based on a propensity score model. Rates of asthma-related hospitalizations and asthma exacerbations were evaluated while on treatment as the number of events per patient-year (PPY) and compared between weighted cohorts using rate ratios (RRs) with 95% confidence intervals (CIs). Rates of asthma-related hospitalizations were assessed for non-inferiority using a fixed-margin approach.
Results: Overall, 1055 and 1218 patients were included in the mepolizumab and dupilumab cohorts, respectively (mean age 70.1 and 67.4 years). Baseline characteristics were well balanced after weighting. Mepolizumab demonstrated non-inferiority to dupilumab for asthma-related hospitalizations within the overall population (RR 0.71, 95% CI 0.46, 1.08; p = 0.113; non-inferiority margin 1.10) and superiority to dupilumab within the adherent subgroup (RR 0.54, 95% CI 0.30, 0.99; p = 0.047). Mepolizumab was also associated with significantly lower rates of asthma exacerbations than dupilumab in the overall population (RR 0.85, 95% CI 0.72, 1.00; p = 0.047) and directionally favorable rates in the adherent subgroup (RR 0.82, 95% CI 0.63, 1.05; p = 0.116).
Conclusions: Among Medicare FFS beneficiaries, mepolizumab demonstrated comparable real-world effectiveness to dupilumab for asthma-related hospitalizations and was associated with significantly lower rates of asthma exacerbations, supporting mepolizumab as an effective treatment option for older, clinically complex patients with asthma.
Mepolizumab和dupilumab是用于治疗未控制哮喘的生物疗法，尽管这两种药物之间的直接比较现实证据有限。本研究比较了mepolizumab和dupilumab在老年和临床复杂的医疗保险服务收费（FFS）受益人哮喘人群中的哮喘相关住院和哮喘加重情况。方法：使用来自Komodo研究数据库（2018年1月1日- 2025年5月31日）的数据，确定在2019年1月1日（指标日期）或之后首次申请mepolizumab或dupilumab的哮喘医疗保险FFS受益人，以及坚持指标生物制剂≥6个月的患者亚组。使用基于倾向评分模型的重叠加权来平衡队列。在治疗期间，评估哮喘相关住院率和哮喘加重率为每患者年事件数（PPY），并使用95%置信区间（ci）的比率比（rr）在加权队列之间进行比较。使用固定边际方法评估哮喘相关住院率的非劣效性。结果：总体而言，分别有1055例和1218例患者被纳入mepolizumab和dupilumab队列（平均年龄70.1岁和67.4岁）。加权后基线特征得到很好的平衡。在总体人群中，Mepolizumab在哮喘相关住院治疗中表现出对dupilumab的非劣效性（RR 0.71, 95% CI 0.46, 1.08; p = 0.113；非劣效性边际1.10），在粘附亚组中表现出对dupilumab的优越性（RR 0.54, 95% CI 0.30, 0.99; p = 0.047）。在总体人群中，Mepolizumab与dupilumab的哮喘发作率也显著低于dupilumab (RR 0.85, 95% CI 0.72, 1.00; p = 0.047)，并且在粘附亚组中，Mepolizumab的方向有利（RR 0.82, 95% CI 0.63, 1.05; p = 0.116）。结论：在Medicare FFS受益人中，mepolizumab在哮喘相关住院治疗中表现出与dupilumab相当的实际有效性，并且与哮喘加重率显着降低相关，支持mepolizumab作为老年，临床复杂的哮喘患者的有效治疗选择。
期刊介绍：
Advances in Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all therapeutic areas. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged.
The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Advances in Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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