Prospective direct comparison of biological treatments on severe eosinophilic asthma: Findings from the PRISM study.

BACKGROUND: Although various monoclonal antibodies have been used as add-on therapy for eosinophilic severe asthma (ESA), no direct head-to-head comparative study has evaluated their efficacy.

OBJECTIVE: To compare the efficacy of reslizumab, mepolizumab, and dupilumab in patients with ESA through a multicenter prospective observational study.

METHODS: Ninety-six ESA patients who had received one of these biological agents for at least six months were included in the study. Cox proportional hazard models were used to compare the risk of the first exacerbation event. The annual exacerbation rate was analyzed using a negative binomial model, and a mixed-effect model was used to analyze changes in forced expiratory volume in 1 s (FEV1) and asthma control test (ACT) score over time.

RESULTS: In comparison to reslizumab adjusted for sputum eosinophils and common asthma-related covariates, the hazard ratios and 95% confidence intervals (CIs) of the first exacerbation incidence were 2.90 (0.92-9.16) and 2.69 (0.87-8.29) for dupilumab and mepolizumab, respectively. During the follow-up period, the dupilumab group was more likely to experience exacerbation compared to the reslizumab group (rate ratio and 95% CI: 3.97 [1.17-14.74]). No differences were observed when the models were adjusted for blood eosinophil counts. Both the FEV1 and ACT improved after treatment, but no group differences were found.

CONCLUSION: Three biologics were equally effective as add-on therapy for ESA. Reslizumab may have an advantage in preventing future exacerbation compared to dupilumab. Sputum eosinophils may be a useful consideration when choosing a biological treatment.