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Effect of Anti-IL5, Anti-IL5R, Anti-IL13 Therapy on Asthma Exacerbations: A Network Meta-analysis

Abstract

Background

Several new treatments for severe asthma have become available in the last decade; yet, little data exist to guide their use in specific patient populations.

Objective

A network meta-analysis was conducted comparing the efficacy of FDA-approved monoclonal antibody therapies in preventing exacerbations in patients with severe eosinophilic asthma.

Methods

PubMed and Ovid were searched from inception until July 2019 for randomized controlled trials that studied the efficacy of benralizumab, dupilumab, mepolizumab, and reslizumab, in preventing acute exacerbations of asthma. Studies were included if they reported data for patients with severe eosinophilic asthma (defined in this meta-analysis as absolute eosinophil count ≥ 250 cells/μL). Annualized rate ratios for asthma exacerbations (during treatment) were calculated and converted to log rate ratios. Direct and indirect treatment estimates (for inter-drug differences) were analyzed using frequentist network meta-analysis methodology in R and treatments were ranked based on P-scores.

Results

In total, nine studies were included in the final analysis. Network meta-analysis revealed that all drugs were superior to placebo in preventing rates of asthma exacerbation in the study population and no inter-drug differences existed. Dupilumab was found to have the greatest magnitudes of effect on decreasing log rate ratio of asthma exacerbation based on P-score (0.83).

Conclusion

Benralizumab, dupilumab, mepolizumab, and reslizumab are all associated with decreased asthma exacerbations in patients with eosinophilic asthma, with no significant inter-drug differences.

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Funding

This study was not sponsored by any funding agency or pharmaceutical company.

Author information

IHI had full access to all of the extracted data in the network meta-analysis and takes responsibility for the integrity of the data and the accuracy of the data analysis. IHI conceptualized and designed the study protocol, conducted the analyses and wrote the first draft manuscript. IHI and RPR contributed to assessment of study quality. Both authors contributed substantially to the interpretation of analyses and in revisions of manuscript.

Correspondence to Imran H. Iftikhar.

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Ramonell, R.P., Iftikhar, I.H. Effect of Anti-IL5, Anti-IL5R, Anti-IL13 Therapy on Asthma Exacerbations: A Network Meta-analysis. Lung 198, 95–103 (2020). https://doi.org/10.1007/s00408-019-00310-8

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Keywords

  • Eosinophilic asthma
  • Benralizumab
  • Dupilumab
  • Mepolizumab
  • Reslizumab