Decreasing frequency of dupilumab is associated with stable asthma in select populations

SESSION TITLE: Asthma Biologic Update SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Dupilumab use is associated with improved exacerbations and symptoms in patients with severe uncontrolled eosinophilic asthma. The duration of use is currently thought to be indefinite. However, this may not be necessary in all patients. Decreasing inhaled therapy in well controlled asthmatics is recommended under current guidelines. No such guidelines exist for biologics. We aim to determine whether decreasing the frequency of dupilumab allows well-controlled asthmatics the same level of asthma control with fewer injections. METHODS: Patients who were changed to dupilumab every four weeks by their primary pulmonologist were retrospectively reviewed for outcomes. The asthma biologics program at our institution is centralized to a small group of providers, pharmacists, and nurses; patient data is regularly tracked for quality assurance. Patients were considered to have well-controlled asthma if they met the following definitions: ACT (Asthma Control Test) > 19, AIRQ 0-1, or met GINA guidelines for well-controlled. Individual chart review was completed for all patients, and pharmacy records were reviewed for oral corticosteroid courses. Groups were compared using student t-test. RESULTS: There were 20 patients included in the analysis. Most patients were female (75%), with a mean age of 51.86 +/- 17.99. Fifty-five percent of patients were Black. The median time between starting dupilumab and changing to every four weeks was 612.5 days. At the time of the dosing change the population had well-controlled asthma based on ACT 22.78+/- 2.42 with normal FEV1% 86.6 +/-16.38. None of the patients had been hospitalized or seen in urgent care in the past year. The decision to change dupilumab to every four weeks was primarily based on clinical remission (17/20). The other reasons for dosing change or cessation of medication were related to adverse effects (10%) and loss of medication coverage (10%). The patients were followed for a median of 239 days post-dosage change. 47.6% of patients tolerated adjustment of the dose and stayed on q4 week dupilumab. Tolerance was assessed by subjective patient reports as well as maintenance of asthma control based on prior criteria and the absence of exacerbations. 3(15%) patients experienced an exacerbation all secondary to URI requiring oral corticosteroids. Intolerance for most patients was based on subjective worsening of their asthma symptoms. For patients who did not tolerate the dose adjustment, the average time before patients had to revert to Q2 was 119.11 +/- 48.7 days. CONCLUSIONS: Every 4 week dosing of dupilumab to every four weeks was well tolerated by almost half of our population. The principal reason for returning to two week dosing was related to subjective worsening of asthma. CLINICAL IMPLICATIONS: Well controlled asthmatics on dupilumab may tolerate a reduction in their dosing frequency. The utility of this adjustment requires future investigation. DISCLOSURES: No relevant relationships by Emily Garvey Advisory Committee Member relationship with AstraZeneca Please note: 2018 to present Added 03/31/2023 by Jessica Most, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Genetech Please note: 2021-2022 Added 03/31/2023 by Jessica Most, source=Web Response, value=Honoraria No relevant relationships by Bita Naimi No relevant relationships by Gurston Nyquist No relevant relationships by Damaris Pena Evertz No relevant relationships by Mindy Rabinowitz No relevant relationships by Marc Rosen Speaker/Speaker's Bureau relationship with GSK Please note: 1/1/2022 Added 04/02/2023 by Elina Toskala, source=Web Response, value=Honoraria Research funding relationship with GSK Please note: 6/1/2022 Added 04/02/2023 by Elina Toskala, source=Web Response, value=Grant/Research Support Consultant relationship with Aerin Please note: 1/1/2023 Added 04/02/2023 by Elina Toskala, source=Web Response, value=Consulting fee Research funding relationship with Optinose Please note: 1/1/2022 Added 04/02/2023 by Elina Toskala, source=Web Response, value=Grant/Research Support