Personalised dupilumab therapy in severe asthma: real-world dosing interval prolongation among early responders

In severe uncontrolled asthma, dupilumab has been shown to reduce exacerbations and symptom burden. In other type 2 conditions, the dosing interval has been successfully prolonged while maintaining disease control.

Here, we aim to assess if dupilumab dosing intervals can be prolonged in severe asthma while maintaining disease control.

24 dupilumab early responders underwent a trial of dosing interval prolongation. We assessed spirometry, symptom control and exacerbations at baseline pre-biologic(Visit(V)1), post biologic with the licensed 2 week dosing(V2) and then following prolonging the dosing interval(V3). Bonferroni corrected pairwise comparisons were made between time points.

Mean (SEM) baseline demographics were: age 50.4 years (2.9); BMI 30.6kg/m²(1.00). No patients were on maintenance OCS. The median duration between V1-V2 was 6.7 months followed by 8.6 months between V2-V3. The median(range) prolonged dosing interval at V3 was 4(2-6) weeks. There were significant differences for all outcomes comparing V1 vs either V2 or V3, but no significant difference between V2 vs V3. The mean(95%CI) values for V1, V2 and V3 respectively were: FEV1 % predicted 79.3% (70.6, 88.1), 93.5%(86.8, 100.2) and 94.2% (87.2, 101.1); FeNO 94.1ppb (73.0, 115.2), 22.8ppb (17.7, 27.9) and 24.9ppb (17.7, 30.6); Eosinophils 857cells/μL (697, 1017), 473 cells/μL (336, 610) and 500 cells/μL (344, 656); ACQ-6 3.0 (2.6, 3.6), 0.7 (0.5, 0.9) and 0.5 (0.3, 0.6); AER 3.8 (3.0, 4.5), 0.0 and 0.0.

The majority of dupilumab early responders were able to successfully prolong their dosing interval while maintaining disease control. This in turn may have implications for drug costs and patient convenience.