The following is a summary of “Comparative effectiveness of omalizumab, mepolizumab, and dupilumab in asthma: A target trial emulation,” published in the MAY 2023 issue of Allergy & Immunology by Akenroye, et al.

For a study, researchers sought to compare the effectiveness of three monoclonal antibodies (mAbs) – omalizumab, mepolizumab, and dupilumab – in individuals with moderate-to-severe asthma.

The study emulated a hypothetical randomized trial using electronic health records from a large US-based academic healthcare system. Eligible participants were 18 or older, had baseline IgE levels between 30 and 700 IU/mL, and peripheral eosinophil counts of at least 150 cells/μL. The study period covered March 2016 to August 2021. The primary outcomes assessed were the incidence of asthma-related exacerbations and the change in baseline forced expiratory volume in 1 second (FEV₁) value over 12 months of follow-up.

A total of 68 individuals receiving dupilumab, 68 receiving omalizumab, and 65 receiving mepolizumab met the inclusion criteria. Over the 12-month follow-up period, the incidence rates of exacerbations per person-year were 0.46 for the dupilumab group, 0.93 for the omalizumab group, and 1.32 for the mepolizumab group. Adjusted incidence rate ratios comparing dupilumab to mepolizumab and dupilumab to omalizumab were 0.28 (95% CI = 0.09-0.84) and 0.36 (95% CI = 0.12-1.09), respectively. The incidence rate ratio comparing omalizumab to mepolizumab was 0.78 (95% CI = 0.32-1.91). Regarding the change in FEV₁, there were no statistically significant differences between the groups: dupilumab versus mepolizumab (0.11 L, 95% CI = –0.003 to 0.222 L), dupilumab versus omalizumab (0.082 L, 95% CI –0.040 to 0.204 L), and omalizumab versus mepolizumab (0.026 L, 95% CI –0.083 to 0.140 L).

Among patients with moderate-to-severe asthma and eosinophil counts of at least 150 cells/μL and IgE levels of 30 to 700 kU/L, dupilumab showed more significant improvements in exacerbation rates and FEV₁ values compared to omalizumab and mepolizumab. The findings suggested that dupilumab may be more effective in this patient population.

Source: jacionline.org/article/S0091-6749(23)00144-6/fulltext