In the real world, dupilumab has been as effective as the results in clinical trials, and patients are seeing low exacerbation rates, emergency department visits, and hospitalizations, explained Neal Jain, MD, FAAP, FAAAAI.
In the real world, dupilumab has been as effective as the results in clinical trials, and patients are seeing low exacerbation rates, emergency department visits, and hospitalizations, explained Neal Jain, MD, FAAP, FAAAAI, director of research at Arizona Allergy & Immunology Research and a co-owner of Arcadia Allergy & Asthma and San Tan Allergy & Asthma.
How have the real-world results of dupilumab in asthma stood up to the findings from the clinical trials?
I mean I would, you know, be lying if I said that it worked in every individual all the time, but I would say that, you know, in comparison to what we've seen with some of the other biologics, where we've had a lot of high hopes, dupilumab has really been the 1 medication that at least I and I know several other allergist and respiratory specialist pulmonologist reach for, because we are pretty sure that it's going to work, and it's going to work quickly, and it's going to match what we've seen in the clinical trials with really profound efficacy and improving lung function and reducing exacerbations and reducing the need for oral steroids.
And just improving control of again, not only their lower airway disease, but their upper airway disease. So, it has been really reassuring to see that what we've seen in the real-world matches what we've seen based on the clinical trials.
How does dupilumab reduce exacerbation? What have we seen about its ability to minimize emergency department or urgent care visits and hospitalizations?
Yeah, so I mean, I think consistent with what we've seen from the clinical trials, dupilumab has been really quite a good medication at reducing the need for oral steroids, and the need for ER [emergency room] visits, hospitalizations—asthma exacerbations are you know the number one reason that we would use an oral steroid.
And so, you know, I would say that when you look at the raw exacerbation rates and the clinical trials for dupilumab, those raw exacerbation rates, depending upon biomarker status were anywhere from point 0.2 to 0.5 in that range. And I would say that that's consistent in the individuals that we've seen who've been on medication. It's rare that we see them having exacerbations of their asthma, and it's rare that we see them needing oral steroids.
I would say the exception are those that are early on in therapy who were oral steroid dependent and have ultra-high, T2-high disease, where they have these massively elevated biomarkers with very high eosinophils are on oftentimes very high doses of oral steroids. And those individuals, early on, I would say, we often see that they may still have sort of a little bump or flare of their asthma, but as they've been on therapy longer, at least what I've seen, is that they really have good control of their disease—and those are the most burdensome patients—and over time I've seen as they've been on therapy for months to years, that their asthma really comes under quite good control with low exacerbation rates, ER visits, and hospitalizations.