Comparative Effectiveness of Dupilumab Versus Mepolizumab and Benralizumab in Asthma: A Multinational Retrospective Cohort Study.

Abstract

Several biologic agents have been approved for asthma treatment. However, previous comparative effectiveness studies have been indirect treatment comparisons or restricted in geographical scope. To compare the effectiveness of dupilumab versus mepolizumab and benralizumab in reducing asthma exacerbations among patients with asthma. Data from the Global Collaborative Network of TriNetX were used. Patients aged ≥18 years who received dupilumab, mepolizumab, or benralizumab for asthma between November 1, 2018, and January 1, 2024, were included. The primary outcome was time to the first asthma exacerbation within the 1-year follow-up period. Two comparisons were performed: (1) dupilumab versus mepolizumab and (2) dupilumab versus benralizumab. Propensity score matching was used to balance covariates between the groups. The risk of asthma exacerbations was estimated using Kaplan-Meier curves and Cox proportional hazards models. Subgroup analyses were conducted based on eosinophil counts (≥300, ≥150 to <300, and <150 cells/μL), the presence of chronic obstructive pulmonary disease (COPD), and exacerbation history (0 and ≥1 events). Dupilumab was associated with a lower risk of asthma exacerbations compared with mepolizumab (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.62-0.76) and benralizumab (HR, 0.74; 95% CI, 0.67-0.82). Benefits of dupilumab were pronounced in patients with eosinophil counts ≥300 cells/μL, those with COPD, and those without an exacerbation history. Dupilumab was associated with a decreased risk of asthma exacerbations compared with both mepolizumab and benralizumab among patients with asthma. Further research incorporating comprehensive biomarker data is needed to optimize biologic selection.