Dupilumab efficacy in patients with type 2 asthma and early Feno level reductions

Background

The QUEST (ClinicalTrials.gov identifier NCT02414854) and TRAVERSE (NCT02134028) studies demonstrated the efficacy of dupilumab, 200 or 300 mg, versus placebo every 2 weeks for 52 weeks (QUEST) and dupilumab, 300 mg, for an additional 96 weeks (TRAVERSE) in patients with uncontrolled, moderate-to-severe asthma.

Objective

This analysis assessed dupilumab efficacy in patients from QUEST who enrolled in TRAVERSE and were stratified by a reduction in fractional exhaled nitric oxide (Feno) level by week 2 of QUEST.

Methods

Patients with an Feno level of at least 25 ppb at parent study baseline (PSBL) were defined as those with or without a minimally important Feno level reduction/response (a ≥20% reduction in patients with an Feno level of ≥50 ppb and a reduction of >10 ppb in those with an Feno level of <50 ppb at PSBL) by week 2 of QUEST. We assessed annualized severe exacerbation rates (AERs) and changes from PSBL in prebronchodilator FEV₁ value, 5-item Asthma Control Questionnaire score, and Asthma Quality of Life Questionnaire score.

Results

During QUEST, dupilumab (compared with placebo) reduced AER by 58% to 59% across Feno response subgroups (unadjusted AER = 0.392-0.523 for dupilumab vs 1.052-1.280 for placebo) and improved prebronchodilator FEV₁ value regardless of Feno response. These improvements were sustained during TRAVERSE, with a slightly greater magnitude in Feno responders. Dupilumab also improved 5-item Asthma Control Questionnaire and Asthma Quality of Life Questionnaire scores independently of Feno responses.

Conclusion

Dupilumab sustained efficacy for up to 3 years in patients with and without a minimally important early reduction in Feno level. Greater improvements were seen in patients with an early reduction in Feno level, but patients without such a reduction also showed favorable outcomes during their treatment with dupilumab.