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Long-term efficacy of dupilumab versus tezepelumab in asthma
a matching-adjusted indirect comparison
Chapman, K. R., Freemantle, N., Guyot, P., Ledanois, O., Soliman, M., Wang, Z., Xu, Y., Abeysinghe, S., & Cheng, W.-H. (2026). Long-term efficacy of dupilumab versus tezepelumab in asthma: a matching-adjusted indirect comparison. Journal of Allergy and Clinical Immunology: In Practice. https://doi.org/10.1016/j.jaip.2026.02.015
BACKGROUND: Dupilumab is approved for moderate-to-severe asthma with an eosinophilic phenotype in the United States (US) and for severe asthma with type 2 inflammation in ex-US countries. Tezepelumab is globally approved for severe asthma. However, their long-term relative efficacy is unknown.
OBJECTIVE: To estimate the long-term relative efficacy of dupilumab versus tezepelumab using an unanchored matching-adjusted indirect comparison.
METHODS: Individual patient data for dupilumab from TRAVERSE (N=1,368) and associated parent randomized controlled trials (RCTs) were re-weighted to match aggregate tezepelumab data from DESTINATION (N=475) and associated parent RCTs for prognostic factors and treatment effect modifiers. Outcomes included annualized exacerbation rate (AER) of all asthma exacerbations, AER of asthma exacerbations leading to hospitalization and/or emergency room (ER) visits (baseline of RCTs until the end of TRAVERSE/DESTINATION), and change from baseline (CFB) in pre-bronchodilator forced expiratory volume in 1s (pre-BD FEV1) (baseline of RCTs to Week 100/104). Sensitivity analysis (SA) explored key characteristics from the primary analysis.
RESULTS: Dupilumab demonstrated a significantly lower AER of all asthma exacerbations (mean difference [MD]: -0.269, 95%CI: -0.372; -0.166, p<0.0001) and a comparable AER of asthma exacerbations leading to hospitalization and/or ER visits (MD: 0.006, 95%CI: -0.016; 0.027, p=0.62) compared with tezepelumab. Dupilumab exhibited numerically greater improvement in pre-BD FEV1 (MD: -0.064L, 95%CI: -0.132; 0.005, p=0.07), with a significantly higher CFB in SA (MD: -0.153L; 95%CI: -0.207; -0.099, p<0.0001).
CONCLUSION: In the matched cohort, long-term dupilumab treatment resulted in a lower AER of all asthma exacerbations relative to tezepelumab, with lung function improvements observed in SA.
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