Indirect Comparison of Dupilumab and Mepolizumab Treatments for Uncontrolled Eosinophilic Asthma

Abstract

The efficacy and safety of dupilumab, a humanized interleukin IL-4 receptor alfa monoclonal antibody mAb that inhibits the signaling of the type 2 cytokines IL-4 and IL-13, for the treatment of uncontrolled eosinophilic asthma remains to be fully characterized, particularly in comparison to other therapeutic mAbs. Therefore, we conducted a meta-analysis of randomized controlled trials RCTs to indirectly compare the ef cacy and safety of dupilumab with those of mepolizumab, a humanized anti-IL-5 mAb, in patients with uncontrolled eosinophilic asthma. Comparisons were made using the Bayesian statistical method. This metaanalysis complies with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA guidelines. Six RCTs were eligible for this study : two RCTs focused on dupilumab and four on mepolizumab. The primary efficacy outcome was a change in the forced expiratory volume at 1.0 second FEV1.0 , and the primary safety outcome was the incidence of severe adverse effects SAE. The mean difference in changes in the FEV1.0 following treatment with dupilumab versus mepolizumab was 0.133 95% CI, 0.016-0.252. There was no signi cant difference between these two agents in the incidence of SAE OR, 1.99 ; 95% CI, 0.19-11.16. These results strongly indicate that dupilumab is more effective than mepolizumab and is generally well-tolerated in patients with uncontrolled eosinophilic asthma.