Indirect comparison of efficacy of dupilumab versus mepolizumab and omalizumab for severe type 2 asthma

Recently, several biologics have been introduced as add-on treatment for severe asthma [1]. The biologics target the underlying mechanism driving the disease and are recommended for specific phenotypes such as mepolizumab (anti-interleukin (IL)-5) for severe eosinophilic asthma [2] and omalizumab (anti-immunoglobulin (Ig)E) for severe allergic asthma [3]; i.e. specific endotypes of type 2 inflammation. Dupilumab (anti-IL-4Rα) is a newer biologic recommended for severe asthma with type 2 inflammation characterised by elevated blood eosinophils (≥150 per μL) and/or exhaled nitric oxide fraction ( F eNO ≥25 ppb) [4]. Due to the IL-4Rα activity of dupilumab it is likely to inhibit two type 2 inflammatory pathways and, therefore, a patient can be eligible for more than one of the biologics, which is challenging in practice as no previous study has compared the efficacy of dupilumab with mepolizumab and omalizumab. This indirect comparison of dupilumab, mepolizumab and omalizumab for patients with severe type 2 asthma fulfilling start-up criteria for more than one drug shows no significant efficacy differences https://bit.ly/3pK9Nf9