A network meta-analysis on the effects of biologics for inadequately controlled asthma
Several biologics have been developed and used for patients with inadequately controlled asthma. However, few studies compared the efficacy between the biologics. Thus, this study aimed to compare the efficacy of the biologics. Randomized controlled trials (RCTs) comparing biologics with placebo or other biologics in patients with inadequately controlled asthma despite high-intensity treatment were retrieved. The outcomes were the annual asthma exacerbation rate (AER), forced expiratory volume per second before bronchodilator use (preBD FEV1), the asthma control questionnaire (ACQ), and asthma quality of life questionnaire (AQLQ) results. The frequentist method of network meta-analysis (NMA) was conducted using a random effects model to calculate incidence rate ratio or standardized mean differences. This NMA included 23 RCTs with eight biologics (omalizumab, dupilumab, benralizumab, reslizumab, mepolizumab, tezepelumab, itepekimab, and astegolimab). In the overall population, no significant differences were observed between the biologics. However, in the subgroup analysis for patients with eosinophil levels ≥300 cells/μL or eosinophilic asthma, dupilumab and tezepelumab significantly outperformed benralizumab, reslizumab, and mepolizumab in improving preBD FEV1. These findings may help clinicians select an appropriate treatment for inadequately controlled asthma by presenting comparative effects among biologics that are not documented in current guidelines.
2024 Spring Convention