Anti-IL-4R versus Anti-IL-5/5R after Anti-IL-5/5R failure in asthma: an emulated target trial.

MeSH benralizumab dupilumab mepolizumab severe asthma treatment switch

Journal

The Journal of allergy and clinical immunology
ISSN: 1097-6825
Titre abrégé: J Allergy Clin Immunol
Pays: United States
ID NLM: 1275002

Informations de publication

Date de publication:
05 Jun 2024
Historique:
received: 26 12 2023
revised: 27 04 2024
accepted: 16 05 2024
medline: 8 6 2024
pubmed: 8 6 2024
entrez: 7 6 2024
Statut: aheadofprint

Résumé

Switching biologics is now common practice in severe eosinophilic asthma. After insufficient response to anti-interleukin 5 or 5 receptor (anti-IL-5/5R), the optimal switch between an anti-IL-4R monoclonal antibody (mAb) (inter-class) or another anti-IL-5/5R drug (intra-class) remains unknown. We compared the effectiveness of these two strategies on asthma control in patients with severe eosinophilic asthma and insufficient response to an anti-IL-5/5R mAb. We emulated a target randomized trial using observational data from the RAMSES Cohort. Eligible patients were switched to an anti-IL-4R mAb or another anti-IL-5/5R drug after insufficient response to an anti-IL-5/5R mAb. The primary outcome was the change in Asthma Control Test (ACT) score at 6 months. Among the 2046 patients in the cohort, 151 were included in the study: 103 switched to an anti-IL-4R mAb and 48 to another anti-IL-5/5R. At 6 months, the difference in ACT score improvement was not statistically significant (mean difference groups, 0.82 [-0.47,2.10], p=0.213). The inter-class group exhibited greater cumulative reduction in oral corticosteroids dose (P After anti-IL-5/5R mAb insufficient response, switching to dupilumab demonstrated similar improvement in ACT scores compared to intra-class switching. However, it appeared more effective in reducing oral corticosteroid use. Larger studies are warranted to confirm these results.

Sections du résumé

BACKGROUND BACKGROUND
Switching biologics is now common practice in severe eosinophilic asthma. After insufficient response to anti-interleukin 5 or 5 receptor (anti-IL-5/5R), the optimal switch between an anti-IL-4R monoclonal antibody (mAb) (inter-class) or another anti-IL-5/5R drug (intra-class) remains unknown.
OBJECTIVE OBJECTIVE
We compared the effectiveness of these two strategies on asthma control in patients with severe eosinophilic asthma and insufficient response to an anti-IL-5/5R mAb.
METHODS METHODS
We emulated a target randomized trial using observational data from the RAMSES Cohort. Eligible patients were switched to an anti-IL-4R mAb or another anti-IL-5/5R drug after insufficient response to an anti-IL-5/5R mAb. The primary outcome was the change in Asthma Control Test (ACT) score at 6 months.
RESULTS RESULTS
Among the 2046 patients in the cohort, 151 were included in the study: 103 switched to an anti-IL-4R mAb and 48 to another anti-IL-5/5R. At 6 months, the difference in ACT score improvement was not statistically significant (mean difference groups, 0.82 [-0.47,2.10], p=0.213). The inter-class group exhibited greater cumulative reduction in oral corticosteroids dose (P
CONCLUSION CONCLUSIONS
After anti-IL-5/5R mAb insufficient response, switching to dupilumab demonstrated similar improvement in ACT scores compared to intra-class switching. However, it appeared more effective in reducing oral corticosteroid use. Larger studies are warranted to confirm these results.

Identifiants

DOI: 10.1016/j.jaci.2024.05.023 PMID: 38848878
pubmed: 38848878
pii: S0091-6749(24)00567-0
doi: 10.1016/j.jaci.2024.05.023
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Investigateurs

G Devouassoux (G)
C Taillé (C)
P Chanez (P)
P Bonniaud (P)
A Bourdin (A)
C Saint Raymond (CS)
C Maurer (C)
A Beurnier (A)
P Roux (P)
V Margelidon (V)
A Boudjemaa (A)
G Mangiapan (G)
N Freymond (N)
T Didi (T)
M Russier (M)
G Garcia (G)
E Popin Meyer (EP)
C Dupin (C)
F Fouquet (F)
S Jouveshomme (S)
W Gaspard (W)
S Dury (S)
S Habib Maillard (SH)
A Izadifar (A)
E Cuvillon (E)
G Deslée (G)
C Barnig (C)
J M Perotin (JM)
A S Gamez (AS)
J P Oster (JP)
N Khayat (N)
C Chenivesse (C)
X Li (X)
C Appere de Vecchi (CA)
A Gicquello (A)
H Rami (H)
G Vignal (G)
N Just (N)
X Blanc (X)
C Leroyer (C)
L Wemeau (L)
A Achkar (A)
C Sattler (C)
E Catherinot (E)
L Guilleminault (L)
M Gaillot-Drevon (M)
C Rochefort-Morel (C)
F Couturaud (F)
P Martin (P)
A Chabrol (A)
H Pegliasco (H)
L Sése (L)
S Romanet (S)
B Caverstri (B)
C Tcherakian (C)
A Magnan (A)
E Ahmed (E)
F Allibe (F)
G Beltramo (G)
K Michaux (K)
N Paleiron (N)
S Martinez (S)
C Begne (C)
C Tummino (C)
C Givel (C)
G Mourin (G)
H Salvator (H)
M Volpato (M)
M Drucbert (M)
N Rossignoli (N)
S Keddache (S)
A Justet (A)
C Andrejak (C)
J Valcke (J)
J Perrin (J)
M Mercy (M)
M Jouvenot (M)
T Soumagne (T)
X Elharrar (X)
B Douvry (B)
B Godbert (B)
B Maitre (B)
C Goyard (C)
A Didier (A)
E Cadet (E)
F Chabot (F)
J Gonzalez (J)
L Mattei (L)
M Gouitaa (M)
S Chauveau (S)
S Raymond (S)
S Dirou (S)
S Fry (S)
A Briault (A)
A Moui (A)
A Paris (A)
E NoelSavina (E)
C Olivier (C)
E Caradec (E)
N Roche (N)
G Picart (G)
L Belmont (L)
L Portel (L)
M Rocca Serra (MR)
N Guibert (N)
R Jean (R)
S Hadjadj (S)
S Guillo (S)
L Gauquelin (L)
C Estellat (C)
A Prigent (A)
M Larrousse (M)
D Jaffuel (D)

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Solène Valery (S)

Service de Pneumologie et Centre de référence pour les maladies respiratoires rares, Hôpital Bichat, AP-HP Nord-Université Paris Cité; UMR 1152, Paris, France; CRISALIS F-CRIN network; Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, équipe PEPITES, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France. Electronic address: candice.estellat@aphp.fr.

Noémie Simon-Tillaux (N)

Equipe 2-Oncostat U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France.

Gilles Devouassoux (G)

Service de Pneumologie, Hôpital de la Croix Rousse, Lyon, France; CRISALIS F-CRIN network.

Philippe Bonniaud (P)

Service de Pneumologie et Soins Intensifs Respiratoire, Centre Hospitalier Universitaire de Bourgogne, Dijon, France. CRISALIS F-CRIN network; INSERM U1231, Equipe HSP-pathies, Faculty of Medicine and Pharmacy, University of Bourgogne-Franche Comté, Dijon, France.

Antoine Beurnier (A)

Department of Respiratory and Intensive Care Medicine, AP-HP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.

Amel Boudjemaa (A)

Service de pneumologie, Centre Hospitalier intercommunal de Créteil, Créteil, France.

Cécile Chenivesse (C)

Univ. Lille, CNRS, Inserm, CHU Lille, Service de Pneumologie et Immuno-Allergologie, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France; CRISALIS, F-CRIN Inserm, network, France.

Arnaud Bourdin (A)

Department of Respiratory Diseases, Univ Montpellier, PhyMedExp, Univ Montpellier, CNRS, INSERM CHU Montpellier, Montpellier, France.

Lisa Gauquelin (L)

Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, équipe PEPITES, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France.

Sylvie Guillo (S)

Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, équipe PEPITES, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France.

Camille Taillé (C)

Service de Pneumologie et Centre de référence pour les maladies respiratoires rares, Hôpital Bichat, AP-HP Nord-Université Paris Cité; UMR 1152, Paris, France; CRISALIS F-CRIN network.

Candice Estellat (C)

Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, équipe PEPITES, AP-HP, Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Paris, France. Electronic address: candice.estellat@aphp.fr.

Classifications MeSH