Comparative Efficacy and Safety of Dupilumab and Benralizumab in Patients with Inadequately Controlled Asthma: A Systematic Review

Abstract

No head-to-head trials have compared the efficacy and safety between the licensed dosage and administration dosage of dupilumab and benralizumab for inadequately controlled asthma. We conducted an indirect treatment comparison to estimate differences in the efficacy and safety between dupilumab and benralizumab for inadequately controlled asthma using the Bayesian approach. The primary efficacy endpoint was annual exacerbation rate (AER). A subgroup analysis by blood eosinophil count was also performed. The primary safety endpoint was the incidence of any adverse events (AAEs). The results demonstrate that there was no significant difference in the AER between dupilumab and benralizumab in overall patients and the subgroup with the blood eosinophil count of <150. However, the AER was significantly lower in the dupilumab group than in the benralizumab group in the subgroup with a blood eosinophil count of ≥150 but <300, and ≥300 with the rate ratio and 95% credible interval of 0.51 (0.29–0.92) and 0.58 (0.39–0.84), respectively. There was no significant difference in the AAEs between the dupilumab and benralizumab groups. This indirect treatment comparison indicates that dupilumab is superior to benralizumab in patients with inadequately controlled asthma having higher blood eosinophil counts. A direct comparison is required to provide definitive evidence. Systematic Review Registration: UMIN-CTR no. UMIN000036256.

Comparative Efficacy and Safety of Tezepelumab and Other Biologics in Patients with Inadequately Controlled Asthma According to Thresholds of Type 2 Inflammatory Biomarkers: A Systematic Review and Network Meta-Analysis

“…However, to evaluate the efficacy of tezepelumab in patients with non-type 2 bronchial asthma in more detail, it is necessary to compare the efficacy of tezepelumab with conventional biologics, including dupilumab, benralizumab, and mepolizumab, in patients with non-type 2 asthma. Previous various NMAs have indirectly compared the efficacy of several biologics for inadequately controlled asthma [ 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. However, tezepelumab has not been compared with other biologics according to type 2 inflammatory biomarker levels.…”

“…This was because dupilumab comprehensively suppresses Th2-dominated type 2 inflammation by inhibiting signaling involving IL-4 and IL-13. Moreover, the degrees of involvement of type 2 inflammation in asthma pathogenesis have been suggested to correlate well with the efficacy of dupilumab [ 3 , 4 , 5 , 12 , 13 , 54 ]. To the best of our knowledge, for the first time, we independently compared the efficacy of tezepelumab with other biologics using the PBEC and FeNO thresholds.…”

Use of Dupilumab in Glucocorticoid-Dependent Asthma

“…31 Our qualitative analysis is consistent with the results of systematic reviews and meta-analyses conducted by Zayed et al 35 and Ando et al which manifested the role of dupilumab and comparative outcomes of biologics that showed the superior efficacy of dupilumab in line with its more extensive inhibition of both allergic and eosinophilic inflammation in asthma. 40 Zayed et al also highlighted the significance of the use of dupilumab in moderate and severe asthma, but the clinical trials were limited to a short duration of use. 35 A similar trend was contemplated in other clinical trials, including the Phase IIb study, but the results were not statistically significant because of the small study population size.…”

Nivolumab plus Ipilimumab versus Existing Immunotherapies in Patients with PD-L1-Positive Advanced Non-Small Cell Lung Cancer: A Systematic Review and Network Meta-Analysis

“…This statistical method is well-established for NMA and is supported by the National Institute for Health and Clinical Excellence and the Haute Autorité de Santé, as well as by the International Society for Pharmacoeconomics and Outcome Research (ISPOR) guidelines for indirect comparison and NMA [ 22 , 23 ]. The methodology of indirect treatment comparison using the NMA statistical method is useful for comparing treatment regimens in the absence of RCTs performing direct comparisons [ 24 ], which has been adapted in a variety of fields of clinical research [ 25 , 26 , 27 , 28 ]. For the present analysis, we used the standard method of NMA described by Dias et al [ 29 , 30 , 31 ].…”