Indirect Comparison of Dupilumab and Mepolizumab Treatments for Uncontrolled Eosinophilic Asthma: Bayesian Analysis of Randomized Controlled Trials

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 efficacy 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 meta-analysis 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 significant 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.