WITHDRAWN

Abstract

SESSION TITLE: Biologics and Severe Asthma: Latest Outcome Data SESSION TYPE: Original Investigations PRESENTED ON: 10/16/22 10:30 AM - 11:30 AM PURPOSE: Dupilumab which is an anti-IL-4/13 monoclonal antibody can be used to treat severe uncontrolled asthma. Since its approval, patients who were uncontrolled on other biological therapies are switched to Dupilumab. Our study aims to evaluate the efficacy and safety of switching Mepolizumab to Dupilumab for the treatment of severe asthma in a real-world severe asthma clinic in a tertiary hospital in Riyadh, Saudi Arabia. METHODS: We did a chart review on severe asthma patients who were treated with Mepolizumab for at least 6 months with suboptimal asthma control and are currently on Dupilumab for more than 6 months from January 2017 through August 2021. Multiple outcomes were observed which include the rate of asthma exacerbation (RAE), reduction in maintenance Oral Corticosteroids (mOCS) dose, improvement in Asthma Control, lung function, and effects on total IgE and eosinophils. RESULTS: A total of 14 severe asthma patients (85% females) were on mepolizumab for at least 6 months then switched to Dupilumab. The average age was 43 years with an average BMI of 31, half of the patients have a background of Chronic Rhinosinusitis with Nasal Polyposis. At baseline prior to mepolizumab, patients had an average of 18.5 Emergency Room (ER) visits and 14.5 short courses of Prednisone due to asthma exacerbations. Their average Asthma Control Test (ACT) was 10 at baseline and 57% of them were on mOCS at baseline. The average FEV1 pre-bronchodilator (BD) was 1.67 L. Eosinophils count prior to Mepolizumab was 0.77 and total IgE was 317. After a minimum of 6 months on Mepolizumab, results were as follows: both average ER visits and short courses of Prednisone for asthma attacks were reduced to 3.7 and 5 respectively. The average Asthma Control Test (ACT) improved to 13.2. All 14 patients were uncontrolled on Mepolizumab with 23.7% of them were on mOCS. Their average FEV1 was 1.86. Prior to Dupilumab, the average peripheral eosinophils was 0.23 along with 332 for total IgE. 6 months post-Dupilumab initiation, there was a significant improvement in multiple outcomes. The average RAE was 1.42 and ACT was 18.1. Only 10% of patients are on mOCS. Furthermore, the average FEV1 has also improved compared to previous results with pre FEV1 of 2.48 (82%) and the average total IgE was 156. However, eosinophils were higher compared to Mepolizumab period with an average count of 1.54 and 0.92 at 3 and 6 months period. CONCLUSIONS: In this retrospective real-life study, we have shown that switching patients who were uncontrolled on Mepolizumab to Dupilumab had a significant effect in reducing annual asthma exacerbations. It also helped in reducing daily OCS dose along with improvement in lung function and asthma symptoms. Overall, Dupilumab was a safe medication apart from an increase in eosinophils count. CLINICAL IMPLICATIONS: Dupilumab showed that it can improve severe asthmatics who failed Mepolizumab. DISCLOSURES: No relevant relationships by Riyad Al-Lehebi No relevant relationships by Yasmin Alkhunaizi No relevant relationships by SAUD ALMOUSA