TY - JOUR
T1 - Comparative efficacy of tezepelumab to mepolizumab, benralizumab, and dupilumab in eosinophilic asthma
T2 - A Bayesian network meta-analysis
AU - Nopsopon, Tanawin
AU - Lassiter, Grace
AU - Chen, Ming Li
AU - Alexander, G. Caleb
AU - Keet, Corinne
AU - Hong, Hwanhee
AU - Akenroye, Ayobami
N1 - Funding Information:
A. Akenroye is supported by the National Institutes of Health /National Institutes on Minority Health and Health Disparities K99/R00 Maximizing Opportunities for Scientific and Academic Independent Careers Award (K99MD015767) and the Brigham and Women’s Hospital Minority Faculty Career Development Award.
Funding Information:
A. Akenroye is supported by the National Institutes of Health/National Institutes on Minority Health and Health Disparities K99/R00 Maximizing Opportunities for Scientific and Academic Independent Careers Award (K99MD015767) and the Brigham and Women's Hospital Minority Faculty Career Development Award.
Publisher Copyright:
© 2022 American Academy of Allergy, Asthma & Immunology
PY - 2023/3
Y1 - 2023/3
N2 - Background: It is unclear how the efficacy of tezepelumab, approved for the treatment of type 2 high and low asthma, compares to the efficacy of other biologics for type 2–high asthma. Objectives: We sought to conduct an indirect comparison of tezepelumab to dupilumab, benralizumab, and mepolizumab in the treatment of eosinophilic asthma. Methods: The investigators conducted a systematic review and Bayesian network meta-analyses. They identified randomized controlled trials indexed in PubMed, Embase, or Cochrane Central Register of Controlled Trials (CENTRAL) between January 1, 2000, and August 12, 2022. Outcomes included exacerbation rates, prebronchodilator FEV1, and the Asthma Control Questionnaire. Results: Ten randomized controlled trials (n = 9201) met eligibility. Tezepelumab (relative risk: 0.63; 95% credible interval [CI]: 0.46-0.86) was associated with significantly lower exacerbation rates than benralizumab and larger improvements in FEV1 compared to mepolizumab (mean difference [MD]: 66; 95% CI: −33 to 170) and benralizumab (MD: 62; 95% CI: −22 to 150), though the 95% CI crossed the null value of 0. Mepolizumab improved the Asthma Control Questionnaire score the most, but this improvement was not significantly different from that of tezepelumab (tezepelumab vs mepolizumab; MD: 0.14; 95% CI: −0.10 to 0.38). For efficacy by clinically important thresholds, tezepelumab, mepolizumab, and dupilumab achieved a >99% probability of reducing exacerbation rates by ≥50% compared to placebo, but benralizumab had only a 66% probability of doing so. Tezepelumab and dupilumab had a probability of 1.00 of improving prebronchodilator FEV1 by ≥100 mL above placebo. Compared to mepolizumab, dupilumab had >90% chance for improving FEV1 by ≥50 mL, but none of the differences between biologics exceeded 100 mL. Conclusions: In individuals with eosinophilic asthma, tezepelumab and dupilumab were associated with greater improvements (although below clinical thresholds) in exacerbation rates and lung function than benralizumab or mepolizumab.
AB - Background: It is unclear how the efficacy of tezepelumab, approved for the treatment of type 2 high and low asthma, compares to the efficacy of other biologics for type 2–high asthma. Objectives: We sought to conduct an indirect comparison of tezepelumab to dupilumab, benralizumab, and mepolizumab in the treatment of eosinophilic asthma. Methods: The investigators conducted a systematic review and Bayesian network meta-analyses. They identified randomized controlled trials indexed in PubMed, Embase, or Cochrane Central Register of Controlled Trials (CENTRAL) between January 1, 2000, and August 12, 2022. Outcomes included exacerbation rates, prebronchodilator FEV1, and the Asthma Control Questionnaire. Results: Ten randomized controlled trials (n = 9201) met eligibility. Tezepelumab (relative risk: 0.63; 95% credible interval [CI]: 0.46-0.86) was associated with significantly lower exacerbation rates than benralizumab and larger improvements in FEV1 compared to mepolizumab (mean difference [MD]: 66; 95% CI: −33 to 170) and benralizumab (MD: 62; 95% CI: −22 to 150), though the 95% CI crossed the null value of 0. Mepolizumab improved the Asthma Control Questionnaire score the most, but this improvement was not significantly different from that of tezepelumab (tezepelumab vs mepolizumab; MD: 0.14; 95% CI: −0.10 to 0.38). For efficacy by clinically important thresholds, tezepelumab, mepolizumab, and dupilumab achieved a >99% probability of reducing exacerbation rates by ≥50% compared to placebo, but benralizumab had only a 66% probability of doing so. Tezepelumab and dupilumab had a probability of 1.00 of improving prebronchodilator FEV1 by ≥100 mL above placebo. Compared to mepolizumab, dupilumab had >90% chance for improving FEV1 by ≥50 mL, but none of the differences between biologics exceeded 100 mL. Conclusions: In individuals with eosinophilic asthma, tezepelumab and dupilumab were associated with greater improvements (although below clinical thresholds) in exacerbation rates and lung function than benralizumab or mepolizumab.
KW - Asthma
KW - Bayesian
KW - benralizumab
KW - comparative effectiveness
KW - dupilumab
KW - eosinophilic
KW - mAb
KW - mepolizumab
KW - network meta-analysis
KW - tezepelumab
UR - http://www.scopus.com/inward/record.url?scp=85146038650&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85146038650&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2022.11.021
DO - 10.1016/j.jaci.2022.11.021
M3 - Article
C2 - 36538979
AN - SCOPUS:85146038650
SN - 0091-6749
VL - 151
SP - 747
EP - 755
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 3
ER -