Dupilumab Boosts Asthma Control and Lung Function

TOPLINE:

Dupilumab reduced airway inflammation and mucus burden and enhanced airway volume and flow, which led to better lung function and improved asthma control in patients with moderate to severe type 2 asthma.

METHODOLOGY:

• Researchers conducted a randomized, phase 4 trial at 72 sites across 14 countries from July 18, 2020, to January 6, 2023, to investigate the effectiveness of dupilumab in patients with moderate to severe type 2 asthma.
• Overall, 109 patients (mean age, 50.4 years; 62% women) who were receiving medium- to high-dose inhaled corticosteroids were randomly assigned to either receive add-on dupilumab 300 mg or placebo once every 2 weeks for 24 weeks.
• The primary endpoints were the percentage of patients with a fractional exhaled nitric oxide (FeNO) concentration below 25 parts per billion (ppb) and t he change in airway volumes at total lung capacity at week 24, assessed by functional respiratory imaging (FRI) analysis.
• FRI was performed using high-resolution CT combined with software to generate lung models for assessing parameters such as airway volume, resistance, wall thickness, ventilation defects, and mucus volume.
• The secondary endpoints were spirometry (prebronchodilator and post-bronchodilator forced expiratory volume in 1 second [FEV1]), mucus plugging, and asthma control assessed by seven-item asthma control questionnaire score (ACQ-7).

TAKEAWAY:

• Patients on dupilumab were significantly more likely to have FeNO levels below 25 ppb at week 24 than those receiving placebo (odds ratio [OR], 9.8; P < .001).
• Improvements in airway volume were observed with dupilumab, although these findings were not statistically significant.
• By week 24, dupilumab reduced mucus plug scores and mucus volume (P_nominal < .001 for both), with noticeable changes starting as early as week 4. It also improved both prebronchodilator and post-bronchodilator FEV1 and asthma control (lower ACQ-7 scores).
• Treatment related adverse events were similar across both groups. One patient discontinued treatment due to a treatment-emergent adverse event in the dupilumab group; no deaths were reported in either of the groups.

IN PRACTICE:

“The VESTIGE study clearly showed that dupilumab, a recombinant human monoclonal antibody that inhibits interleukin (IL)-4 and IL-13 signalling, reduced peripheral airway mucus load in adult patients with uncontrolled moderate to severe type 2 asthma, which occurred alongside a significant reduction in fractional exhaled nitric oxide, as an IL-13–driven marker of inflammation,” wrote the author of a commentary. 

SOURCE:

This study was led by Mario Castro, MD, University of Kansas School of Medicine, Kansas City, Missouri. It was published online on February 10, 2025, in The Lancet Respiratory Medicine. 

LIMITATIONS:

The patient population lacked diversity, with the predominantly White demographic and more than half of the participants from Eastern Europe limiting the generalizability of the study findings. Assessments of total lung capacity and functional residual capacity were prone to errors owing to incorrect breathing patterns, leading to high variability in imaging outcomes. Recruitment during the COVID-19 pandemic might have influenced the composition of patient population. 

DISCLOSURES:

This study was supported by Sanofi and Regeneron Pharmaceuticals. Some authors reported receiving personal fees, consultancy fees, or research support or being part of advisory boards in various pharmaceutical and healthcare companies. All other authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.