Prospective direct comparison of biologic treatments for severe eosinophilic asthma Findings from the PRISM study

Abstract

Background: Although various monoclonal antibodies have been used as add-on therapy for severe eosinophilic asthma (SEA), to the best of our knowledge, no direct head -to -head comparative study has evaluated their ef ficacy. Objective: To compare the ef ficacy of reslizumab, mepolizumab, and dupilumab in patients with SEA. Methods: This was a multicenter, prospective observational study in patients with SEA who had received 1 of these biologic agents for at least 6 months. Cox proportional hazard models were used to compare the risk of the first exacerbation event, adjusting for sputum or blood eosinophils and common asthma -related covariates. The annual exacerbation rate was analyzed using a negative binomial model, and a mixed -effect model was used to analyze changes in forced expiratory volume in 1 second and asthma control test score over time. Results: A total of 141 patients with SEA were included in the analysis; 71 (50%) received dupilumab; 40 (28%) received reslizumab, and 30 (21%) received mepolizumab. During the 12 -month follow-up, 27.5%, 43.3%, and 38.0% of patients in the reslizumab, mepolizumab, and dupilumab groups, respectively, experienced at least 1 exacerbation. However, after adjusting for confounding factors, the dupilumab and mepolizumab groups showed similar outcomes in time -to -first exacerbation, exacerbation rate, forced expiratory volume in 1 second, and asthma control test score to those of the reslizumab group. Conclusion: In patients with SEA, treatment with reslizumab, mepolizumab, and dupilumab resulted in comparable clinical outcomes within a 12 -month period. Trial Registration: The cohort protocol was sanctioned by the Institutional Review Board of each study center (clinicaltrial.gov identifier NCT05164939). (c) 2023 American College of Allergy, Asthma & Immunology. All rights reserved.