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. 2022 Oct 3:13:992731.
doi: 10.3389/fphar.2022.992731. eCollection 2022.

Dupilumab efficacy and safety in patients with moderate to severe asthma: A systematic review and meta-analysis

Mohamed Sayed Zaazouee  1 , Asmaa Gomaa Alwarraqi  2 , Yasmine Adel Mohammed  3 , Mohamed A Badheeb  4 , Abdullah Mohamed Farhat  5 , Mohammed Eleyan  6   7 , Afnan Morad  3 , Marwa Abdel-Aziz Zeid  8   9 , Aya Shaban Mohamed  10 , Hazem AbuEl-Enien  11 , Ahmed Abdelalim  12 , Ahmed Bostamy Elsnhory  13 , Yasmin S M Hrizat  14 , Nagat Taha Altahir  15 , Doaa Atef  16 , Alaa Ahmed Elshanbary  2 , Khalaf F Alsharif  17 , Khalid J Alzahrani  17 , Mohammad Algahtani  18 , Abdulrahman Theyab  18   19 , Yousef M Hawsawi  19   20 , Ahmed A Aldarmahi  21 , Mohamed M Abdel-Daim  22   23
Affiliations

Dupilumab efficacy and safety in patients with moderate to severe asthma: A systematic review and meta-analysis

Mohamed Sayed Zaazouee et al. Front Pharmacol. .

Abstract

Background: Dupilumab is a human monoclonal antibody directed against the alpha subunit of the interleukin-4 receptor and inhibits the signaling of IL-4 and IL-13. It is approved for treating asthma and other type-2 inflammatory diseases. There is a conflict in the literature regarding the safety and efficacy of dupilumab. Thus, we aimed to assess the safety and efficacy of dupilumab in patients with moderate to severe asthma. Methods: Six databases (PubMed, Embase, Scopus, Web of Science, Cochrane library, and clinicaltrials.gov registry) were searched until January 2022. We included randomized controlled trials that compared dupilumab with the placebo in moderate to severe asthma patients. We extracted the data at 12 and 24 weeks and analyzed them using review manager 5.4. Findings: Thirteen trials were included. Dupilumab significantly improved the forced expiratory volume in 1 s, asthma control questionnaire score, the fraction of exhaled nitric oxide level, and immunoglobulin E level at 12 and 24 weeks (p < 0.05). However, it was associated with increased blood eosinophils at 12 and 24 weeks. Dupilumab was generally a safe agent for asthmatic patients. It showed no significant difference compared with the placebo regarding most adverse events. Conclusion: Dupilumab improves pulmonary function and reduces local and systemic inflammatory markers with minimal adverse events in patients with moderate to severe asthma.

Keywords: asthma; dupilumab; meta-analysis; monoclonal antibody; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram of the included studies.
FIGURE 2
FIGURE 2
Summary and graph of risk of bias assessment results for the included studies.
FIGURE 3
FIGURE 3
Results of the FEV1 change at the 12th week.
FIGURE 4
FIGURE 4
Results of the FEV1 change at the 24th week.
FIGURE 5
FIGURE 5
Results of the ACQ change at the 12th week.
FIGURE 6
FIGURE 6
Results of the ACQ change at the 24th week. (A) Before sensitivity analysis. (B) After sensitivity analysis.
FIGURE 7
FIGURE 7
Mechanism of action of dupilumab through different sites.
See this image and copyright information in PMC

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