Systematic review and MAIC of OCS reduction with biologic asthma treatments

Abstract

Background: Relative efficacy of biologics in reducing oral corticosteroid (OCS) use in severe asthma is not fully characterized. Aims and Objectives: To perform matching-adjusted indirect comparisons (MAIC) of benralizumab vs. mepolizumab and vs. dupilumab in reducing OCS and exacerbation rates in severe asthma. Methods: Patient-level data for the benralizumab ZONDA trial were weighted to match treatment effect–modifying patient characteristics in trials for mepolizumab (SIRIUS) and dupilumab (LIBERTY VENTURE). Results after matching are reported. Results: For MAIC of benralizumab vs. mepolizumab and vs. dupilumab, effective sample sizes were 49% and 25% of the ZONDA population, respectively. Mean difference (benralizumab minus mepolizumab) for OCS reduction from baseline was 6.08 (95% CI −22.22–34.38; p=0.67) by Week 24 (figure). Odds ratio (OR) of OCS elimination was 2.32 (95% CI 0.48–11.15; p=0.29) for benralizumab vs. mepolizumab. Benralizumab reduced exacerbations by 44% vs. mepolizumab (p=0.11). Mean difference (benralizumab minus dupilumab) for OCS reduction was −0.71 (95% CI −20.56–19.15; p=0.94). OR of OCS elimination was 2.26 (95% CI 0.52–9.84; p=0.28) for benralizumab vs. dupilumab. Benralizumab reduced exacerbations by 50% vs. dupilumab (p=0.15). Conclusions: MAIC analysis indicates benralizumab is similar to mepolizumab and dupilumab for OCS dosage reduction, OCS use elimination, and annual exacerbation rate reduction.